Hip Disorders & Ortho Hodgepodge


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Apr 01 2018 29 mins   7
This week on PA Study Sesh, we will talk disorders of the hip as well as a hodgepodge of other orthopedic topics.

* Pelvic Fx:

* High impact or osteoporotic
* CT scan= gold standard
* Tx: pelvic binder & specialist consult

* Hip Fx:

* Osteoporotic women common
* Externally rotated, Abducted,(first 2 are opposite a dislocation) shortened limb: BREAKS
* Groin pain
* Increased risk of avascular necrosis with femoral neck frature
* Increases risk for DVT/PE

* Hip Dislocation:

* Posteriorly #1
* Adducted, internally rotated, shortened

* HIP is HID
* Exact opposite of shoulder

* Risk to sciatic nerve
* Tx: REDUCE (the answer for all dislocations)

* Legg-Calve Perthes

* Idiopathic avascular osteonecrosis of femoral head & epiphysis in children
* Boys 4-10, often active & thin
* Painless limp, worse at end of day
* Decreased abduction and internal rotation
* X-ray

* Early: increased femoral head density, widening of cartilage space
* Advanced: crescent sign (microfx with collapse)

* Tx:

* Non-weightbearing initially

* Ortho referral

* Resolves spontaneously

* SCFE (slipped capitofemoral syndrome)

* Slipped ice cream off cone
* 7-16 obese, African American male (during growth spurt)
* Hip, KNEE, thigh pain with limp
* Increased external rotation (like a hip fx)
* Tx: non-weight bearing + ORIF

* Developmental Dysplasia of the Hip

* Risk factors

* 1st born (less space in the pelvis)
* Female
* Family hx
* Breech

* Physical exam tests

* Barlow

* Apply posterior pressure (since hips dislocate posteriorly)
* += clunk

* Ortolani

* Abduct & Apply anterior pressure
* + = clunk

* Galeazzi (assess for LLD)

* Flex knees with feet on table, ankles touching buttocks
* Affected hip is shortened

* Clinical diagnosis

* Stress U/S at 3-4 weeks
* Femoral head can’t be seen on x-ray until 3-4 months

* Tx:

* Pavlik Harness
* Avoid swaddling
* Avoid tight fitting clothing
* Monitored with U/S

* FAI (femoral acetabular impingement)

* Pain may be dull or sharp groin pain
* Pincer lesion= acetabulum
* Cam lesion = femoral head
* FADIR= most sensitive, may also have + FABER
* Dx: X-rays, MRI to evaluate soft tissues
* Tx: decrease activity, NSAIDS, PT, Surgical referral

* Labral tear

* Dull or sharp groin pain with possible radiation
* Atrauamatic or insidious onset
* Catching/clicking
* FADIR/FABER +
* Test of choice= MRI Arthrogram
* Conservative vs surgical tx

* Snapping Hip

* Snapping/popping with walking, getting up from a chair, swinging leg
* +/- pain
* Caused from iliopsoas tendon movement
* Increased risk in adolescents, athletes with hyperflexion motion (DANCERS)
* TX: conservative

* Greater Trochanteric Pain Syndrome

* Aka trochanteric bursitis
* #1 cause of lateral hip pain in adults
* Tender to palpation
* Increased with walking, stairs, incline, prolonged standing

* Muscles that insert here are responsible for maintaining upright posture & abduction (the rotator cuff of the hip)

* Pain with resisted abduction
* + Trendelenburg sign