Hip/thigh Surgery Ii

Front 1

a. In what populations is SCFE most common?

Back 1

i. Adolescents
ii. African Americans
iii. Obese children

Front 2

b. What dx should be ruled out in SCFE?

Back 2

i. Hypothyroidism

Front 3

c. How will SCFE present?

Back 3

i. Possible knee pain
ii. Rotation of hip causes pain
iii. Flexed hip externally rotates

Front 4

d. How do you tx SCFE?

Back 4

i. Closed reduction
ii. Percutaneous screws

Front 5

a. What is a cam impingement?

Back 5

i. Patient develops bump along superior lateral neck of femur

Front 6

b. What can cause cam impingement?

Back 6

i. SCFE or DJD

Front 7

c. How will cam impingement present?

Back 7

i. Pain in groin
ii. Decreased motion symptoms may be reproduced by abduction or flexion with internal rotation

Front 8

d. How do you tx cam impingement?

Back 8

i. Maintain flexibility
ii. Injections to decrease inflammation
iii. Arthroscopic resection of bump

Front 9

a. What conditions will a gluteus medius tear imitate?

Back 9

i. Bursitis
ii. External snapping hip

Front 10

b. How will a gluteus medius tear present?

Back 10

i. Lateral hip pain
ii. Tender to palpation over greater trochanter
iii. Resisted abduction
iv. Gluteus medius lurch

Front 11

c. Tx for what condition is associated with a gluteus medius tear?

Back 11

i. Bursitis

Front 12

d. What imaging modality is best for a gluteus medius tear?

Back 12

i. MRI

Front 13

e. How do you tx a gluteus medius tear?

Back 13

i. Conservative
ii. Surgery if conservative tx fails

Front 14

a. Degenerative arthritis can be a sequelae of what conditions?

Back 14

i. AVN
ii. Septic arthritis
iii. Hip fracture
iv. SCFE
v. CDH
vi. Trauma

Front 15

b. What are some predisposing factors for degenerative arthritis?

Back 15

i. Obesity
ii. DJD

Front 16

c. What are some secondary conditions associated with osteoarthritis of the hip?

Back 16

i. Dysplasia
ii. SCFE
iii. Trauma
iv. Metabolic disease

Front 17

d. What is the cure for osteoarthritis?

Back 17

i. There isn’t one

Front 18

a. How do you tx osteoarthritis?

Back 18

i. Reduce pain
ii. Maintain mobility
iii. Minimize disability
iv. Weight loss

Front 19

f. How can weight loss affect osteoarthritis of the hip?

Back 19

i. Total force across hip is 3x body weight

Front 20

g. What type of exercise should someone with osteoarthritis do?

Back 20

i. Low-impact activities
ii. Isometric over isotonic

Front 21

h. What type of surgeries can you do for osteoarthritis?

Back 21

i. Tailored to age and activity level
ii. Osteotomies and arthrodesis v. total hip

Front 22

i. How will osteoarthritis present?

Back 22

i. Gradual onset
ii. Stiffness upon waking, improves with warm up period then gradually worsens
iii. CC thigh or knee pain
1. Trendelenberg gait

Front 23

j. What type of analgesic is contra-indicated for osteoarthritis?

Back 23

i. Narcotics

Front 24

k. How should a physical exam be performed for osteoarthritis?

Back 24

i. Examine walking, standing, sitting, and supine
ii. ROM
iii. + Faber test
iv. Neurologic exam
v. DTR, SLR, sensation, strength

Front 25

l. What type of radiographic images should you get in osteoarthritis?

Back 25

i. AP hip-- standing
ii. Lateral hip

Front 26

m. What should you look for in a radiographic exam of osteoarthritis?

Back 26

i. CDH, SCFE, trauma, AVN, or fracture
ii. Decreased joint space, subchonrdal sclerosis, cysts, marginal osteophytes

Front 27

n. What type of analgesic should you use for osteoarthritis?

Back 27

i. NSAIDs

Front 28

i. Where does AVN usually occur in the hip?

Back 28

1. Femoral head

Front 29

ii. What are the MC etiologies of AVN in the hip?

Back 29

1. Alcoholism
2. Steroid use
3. Sickle cell anemia, chronic renal disease, gouty arthritis

Front 30

iii. How will AVN in the hip present?

Back 30

1. +/- loss of ROM
2. +/- Faber

Front 31

iv. What is the goal of tx for AVN in the hip?

Back 31

1. Prevent femoral head collapse

Front 32

v. What radiographic images can be used to dx AVN?

Back 32

1. AP and lateral hip
2. MRI
3. Bone scan

Front 33

i. What is bursitis?

Back 33

1. Inflammatory condition of the bursa
2. May be related to activity and overuse or direct trauma

Front 34

ii. What are the 2 most important bursae in the hip?

Back 34

1. Greater trochanteric bursa
2. Ischial tuberosity bursa

Front 35

iii. How will bursitis in the hip present?

Back 35

1. Painful palpitation of associated areas
2. Painful with activity

Front 36

iv. What will a radiographic evaluation of the hip reveal?

Back 36

1. Negative

Front 37

v. How do you tx greater trochanter bursitis?

Back 37

1. Avoid crossing legs
2. Avoid sitting for prolonged periods
3. Avoid lying on affected side

Front 38

vi. How do you tx ischial tuberosity bursitis?

Back 38

1. Sit on donut or padded seat
2. Avoid prolonged hip flexion

Front 39

vii. What are some general treatments for both types of hip bursitis?

Back 39

1. NSAIDs
2. Warm moist heat applications
3. Stretching exercises
4. Corticosteroid injection w/ local anesthetic

Front 40

a. What are the symptoms of an upper lumbar nerve entrapment?

Back 40

i. Referred pain to anterior thigh

Front 41

b. What are the symptoms of a lower lumbar nerve entrapment?

Back 41

i. Referred pain to buttocks and posterior thigh

Front 42

c. In what population is pudendal nerve entrapment common?

Back 42

i. Cyclists

Front 43

d. How do you tx nerve entrapment?

Back 43

i. Treat underlying cause of entrapment
ii. Steroid injection

Front 44

a. What causes a hip fracture?

Back 44

i. Almost always trauma
ii. Elderly- low energy
iii. High energy- MVA
iv. Osteoporosis in elderly womens

Front 45

b. What must you ascertain about a fall leading to a hip fracture?

Back 45

i. What caused it?

Front 46

c. What is a major complication of a hip fracture?

Back 46

i. DVT
ii. Begins at time of injury and worsened by surgical trauma

Front 47

d. What are the 2 primary types of hip fractures?

Back 47

i. Intracapsular fracture
ii. Intertrochanteric fractures

Front 48

e. Where does an intracapsular fracture occur?

Back 48

i. Femoral neck
ii. Subcapital fractures

Front 49

f. What is the presentation of a hip fracture?

Back 49

i. Pain
ii. Unable to bear weight
iii. Leg may be shortened and externally rotated

Front 50

g. What should you look for in a hip fracture? What type of images should you take?

Back 50

i. AP hip-- Look at both hips and look for pelvic fractures
ii. Cross-table lateral

Front 51

h. How do you tx an intracapsular fracture in a young adult?

Back 51

i. Preserve the femoral head-- immediate reduction closed or open with internal fixation

Front 52

i. How do you treat an intracapsular fracture in the elderly?

Back 52

i. Non-displaced or in situ fixation; if displaced
ii. Displaced→ hemiarthroplasty

Front 53

j. How do you treat a trochanteric fracture in young adults?

Back 53

i. Perform ORIF emergently

Front 54

k. How do you treat a trochanteric fracture in the elderly?

Back 54

i. Perform within 24 hours of injury

Front 55

l. How do you tx an avulsion fracture of the greater trochanter?

Back 55

i. Crutches
ii. Analgesics