Hip Orthopedics

Front 1

Most of the blood supply of femoral head is derived from _

Back 1

Medial and lateral circumflex arteries

Front 2

HIP range of motion

Back 2

Extension - 20-30 degrees
Flexion - 135 degrees
Abduction - 45-50 degrees
Adduction - 20-30 degrees

Front 3

SEPTIC ARTHRITIS

Back 3

- Pain in anterior aspect of hip joint
- Pseudoparalysis
- Fever
- Possible trauma history
- Hip positioning - external rotation, abduction and mild flexion
- Most common in kids under 4 with no underlying illness
- Order CBC, ESR, CRP, blood cultures (40-50% + ), x ray, ultrasoud (very sensitive for effusion, but not infection), large bore needle aspiration
Treatment - early diagnosis, culture results from synovial fluid, hip arthrotomy

Front 4

Interpretation of aspirate results

Back 4

WBC greater then 50000 cell/mL with 90% PMN's, glucose levels less then serum levels, gram stain can confirm dx in 50% of cases, cultures + in 50-80% of patients

Front 5

COMMON BACTERIAL CAUSES OF SEPTIC ARTHRITIS

HIGH RISK LOW BIRTH WEIGHT NEONATES -

3 MONTHS- 3 YEARS -

OVER 3 YEARS

Back 5

NEONATES - S. aureus, B strep

3 MO- 3 YEARS - H influenza, Staph, Strep

OLDER THEN 3 - S. aureus (50%), Strep (25%)

Front 6

LEGG-CALVE-PERTHES DISEASE

Back 6

PATHOGENESIS - may be related to clotting factors and blood viscosity, also relationship may exist with endocrine abnormalities especially thyroid diseases
PRESENTATION - 4-10 years old, boys, small for age, limping for weeks or months, either no pain or mild pain in knee, limited internal rotation and abduction, Trendelenburg positive, antalgic gait
TREATMENT - relief of weight bearing, bedrest, traction, spica, slings, frames, present goals - maintain hip motion and containment of involved femoral head from bases of treatment, initial goals to restore mobility and to relieve pain, operative and non operative containment
PROGNOSIS - majority fo patients will do well into 5th decade, as many as 50% of untreated patients will develop debilitating arthritis by age 55

Front 7

REFERRED PAN FROM THE HIP

SUPRAPATELLAR REGION - NERVE?

MEDIAL THIGH - ?

BUTTOCK - ?

Back 7

SUPRAPATELLAR REGION - femoral N

MEDIAL THIGH - obturator N

BUTTOCK - sciatic N.

Front 8

OSTEOARTHRITIS

Back 8

- Degenerative disease of the hip
- May be primary or secondary
- Patients present with groin, buttock and/or thigh pain and knee pain
- Therapy dependent on pain and limitations
- TREATMENT - conservative therapy based on preservation of activity - motion and control of pain, surgical treatment often includes total hip replacement
CONSERVATIVE MEASURES FOR OA - activity modification, weight control, tylenol, NSAIDS, injections and assistive devises

Front 9

HIP FRACTURE

Back 9

2 TYPES - intracapsular and extracapsular

PRESENTATION - groin pain (may also present with thigh or knee pain), limb may reveal deformity - externally rotated and shortened, may or may not bear weight, passive and active motion is usually painful
X RAY - AP pelvis, AP hip, shoot-through lateral of hip, MRI, bone scan

Front 10

TYPES OF INTRACAPSULAR FRACTURES

Back 10

CAPITAL

SUBCAPITAL

TRANSCERVICAL

BASICERVICAL

Front 11

TYPES OF EXTRACAPSULAR FRACTURES

Back 11

INTERTROCHANTERIC

SUBTROCHANTERIC

Front 12

HIP DISLOCATION

Back 12

-Anterior hip dislocations occur as result of abduction and external rotation, anterior and inferior if hip is flexed at the time of injury, anterior pubic if hip is extended
- Posterior dislocations occur when longitudinal force is applied in line with femur and acting on adducted hip - MORE COMMON (9:1)
PRESENTATION - posterior dislocations will be flexed at the hip, adducted and internally rotated, anterior dislocations will be externally rotated with varying degrees of flexion and abduction, groin pain of affected side
TREATMENT - emergent reduction, closed reduction is attempted first, unless there is associated fracture of hip or femoral neck (ipsilateral), ideally complete paralysis should be obtained prior to attempt at reduction