Hip and Thigh Disorders

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25 Terms

1
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MVA, ring, avulsion

Pelvic Fratures: Background

-Can be life threatening

-Anatomy

  • Sacrum, coccyx, ilium, ischium, pubis

  • Contains viscera, extensive vascular system, and neural network

-Mechanism of Injury

  • ___, falls

-Types

  • ____ disruptions (“open book” fracture)

  • Sacral fractures

  • Acetabular fractures

  • _________ fractures → more common in younger athletes

2
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stabilize, bleeding, urethra, rectal/vaginal, compression, CT

Pelvic Fractures: Physical Exam and Diagnosis

-PE

  • ______ first!

  • Look for → external ________, ecchymosis, blood at _______, vaginal/rectal bleeding, position of LE and iliac crest

  • Full ______/_________ exam to look for blood and bruising

  • ____________ of pelvic to check for instability

-Diagnosis

  • X-ray is the textbook initial test, while __ is the essential test for diagnosis

  • Possibly vascular and/or urologic imaging

<p><strong>Pelvic Fractures: Physical Exam and Diagnosis </strong></p><p>-PE</p><ul><li><p>______ first!</p></li><li><p>Look for → external ________, ecchymosis, blood at _______, vaginal/rectal bleeding, position of LE and iliac crest </p></li><li><p>Full ______/_________ exam to look for blood and bruising</p></li><li><p>____________ of pelvic to check for instability </p></li></ul><p>-Diagnosis</p><ul><li><p>X-ray is the textbook initial test, while __ is the essential test for diagnosis </p></li><li><p>Possibly vascular and/or urologic imaging </p></li></ul><p></p>
3
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wrapping, hemorrhage, gluteal, iliac, bladder

Pelvic Fractures: Treatment and Complications

-Treatment

  • Pelvic ___________ to reduce the amount of blood loss and stabilize bone fragments

  • Definitive treatment depends on fracture type

-Complications

  • _______________ → veins or superior _______/internal pudendal/internal ______ arteries

  • Neurologic injury → do thorough lower body neuro exam

  • Urogenital injury → _______, urethra, vagina, and rectum

<p><strong>Pelvic Fractures: Treatment and Complications</strong></p><p>-Treatment</p><ul><li><p>Pelvic ___________ to reduce the amount of blood loss and stabilize bone fragments </p></li><li><p>Definitive treatment depends on fracture type </p></li></ul><p>-Complications</p><ul><li><p>_______________ → veins or superior _______/internal pudendal/internal ______ arteries </p></li><li><p>Neurologic injury → do thorough lower body neuro exam </p></li><li><p>Urogenital injury → _______, urethra, vagina, and rectum</p></li></ul><p></p>
4
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intracapsular, intertrochanteric, elderly, trauma

Hip Fractures: Background

-Fracture Classification

  • _______________ → femoral head or neck. Higher rate of nonunion and avascular necrosis. Rarely presents with swelling or bruising.

  • Extracapsular → _______________ (between the trochanters) and subtrochanteric

-Mechanism of Injury

  • Fall in _______ is the most common, while ______ in younger patients is another potential cause

<p><strong>Hip Fractures: Background</strong></p><p>-Fracture Classification </p><ul><li><p>_______________ → femoral head or neck. Higher rate of nonunion and avascular necrosis. Rarely presents with swelling or bruising. </p></li><li><p>Extracapsular → _______________ (between the trochanters) and subtrochanteric </p></li></ul><p>-Mechanism of Injury</p><ul><li><p>Fall in _______ is the most common, while ______ in younger patients is another potential cause </p></li></ul><p></p>
5
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pain, internal rotation, refuse, shortened, externally, MRI

Hip Fractures: Symptoms and Diagnosis

-S/S

  • ____ in hip and groin

  • Pain with ROM (especially ________ _________)

  • ______ to bear weight. Individuals with osteoporosis may still be able to bear weight

  • Leg ____________ and __________ rotated, if the bone is displaced

  • ± swelling and ecchymosis

-Diagnosis

  • X-ray

  • ___ is the preferred imaging modality. Bone scans or CT are also options for occult fractures

<p><strong>Hip Fractures: Symptoms and Diagnosis</strong></p><p>-S/S</p><ul><li><p>____ in hip and groin</p></li><li><p>Pain with ROM (especially ________ _________)</p></li><li><p>______ to bear weight. Individuals with osteoporosis may still be able to bear weight </p></li><li><p>Leg ____________ and __________ rotated, if the bone is displaced </p></li><li><p>± swelling and ecchymosis </p></li></ul><p>-Diagnosis</p><ul><li><p>X-ray</p></li><li><p>___ is the preferred imaging modality. Bone scans or CT are also options for occult fractures </p></li></ul><p></p>
6
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pain, ortho, arthroplasty, stress, non-weight

Hip Fractures: Treatment

-____ control → do this first

-_____ referral/consult (immediately)

-ORIF or ______________ for most hip fractures

  • _____ fractures may be treated with ___-______ bearing

  • Most neck fractures need screw fixation or a joint replacement

<p><strong>Hip Fractures: Treatment</strong></p><p>-____ control → do this first</p><p>-_____ referral/consult (immediately)</p><p>-ORIF or ______________ for most hip fractures</p><ul><li><p>_____ fractures may be treated with ___-______ bearing</p></li><li><p>Most neck fractures need screw fixation or a joint replacement </p></li></ul><p></p>
7
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Intracapsular fracture

#1

<p>#1</p>
8
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Intertrochanteric fracture

#2

<p>#2</p>
9
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Subtrochanteric fracture

#3

<p>#3</p>
10
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Lateral femoral circumflex artery

#1

<p>#1</p>
11
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Round ligament artery

#2

<p>#2</p>
12
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Medial femoral circumflex artery

#3

<p>#3</p>
13
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Deep femoral artery

#4

<p>#4</p>
14
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fractures, alcohol, sickle cell, disruption, ischemia, death

Avascular Necrosis (Aseptic Necrosis): Background

-Risk Factors

  • Trauma → __________ (femoral neck, scaphoid), dislocations (hip)

  • __________ use

  • Glucocorticoid use

  • _______ _____ disease

-Pathogenesis (trauma)

  • ___________ of blood supply → _________ → ______ of bone and marrow cells

15
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dull, groin, antalgic, decreased, xray, crescent, ortho

AVN: S/S, Diagnosis, and Treatment

-S/S

  • ____, aching, ______ pain

  • Pain with weight bearing = _______ gait

  • Pain with hip ROM = ____________ ROM

-Diagnosis

  • _____ is the initial imaging of choice (mild density changes → sclerosis/cysts)

  • MRI → ________ sign

-Treatment

  • Refer to ______

<p><strong>AVN: S/S, Diagnosis, and Treatment</strong></p><p>-S/S</p><ul><li><p>____, aching, ______ pain </p></li><li><p>Pain with weight bearing = _______ gait</p></li><li><p>Pain with hip ROM = ____________ ROM</p></li></ul><p>-Diagnosis</p><ul><li><p>_____ is the initial imaging of choice (mild density changes → sclerosis/cysts) </p></li><li><p>MRI → ________ sign</p></li></ul><p>-Treatment</p><ul><li><p>Refer to ______</p></li></ul><p></p>
16
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energy, MVA, fall, sports, pain, shortening, bleeding

Femur Shaft Fracture: Background

-Mechanism of Injury

  • High _______ force → ___, being struck by car, fall from height, gunshot wound

  • Low energy force → ____ from stumbling or low height, ________

-S/S

  • ____, swelling, deformity

  • ____________ of thigh

  • Soft tissue injury and _________

-Diagnosis

  • X-ray → get other views to rule out other fractures

<p><strong>Femur Shaft Fracture: Background</strong></p><p>-Mechanism of Injury </p><ul><li><p>High _______ force → ___, being struck by car, fall from height, gunshot wound </p></li><li><p>Low energy force → ____ from stumbling or low height, ________</p></li></ul><p>-S/S</p><ul><li><p>____, swelling, deformity </p></li><li><p>____________ of thigh</p></li><li><p>Soft tissue injury and _________</p></li></ul><p>-Diagnosis</p><ul><li><p>X-ray → get other views to rule out other fractures</p></li></ul><p></p>
17
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stabilization, tetanus, infection, nonunion, hemorrhage, compartment, fat emboli

Femur Shaft Fracture: Treatment and Complications

-Treatment

  • Initial → __________ if unstable, pain control, immobilization

  • If open fracture, add antibiotics and ________ prophylaxis

  • Ortho consult

-Complications

  • ___________, malunion, delayed union, __________, pain d/t ortho hardware

  • _____________, neurovascular injury, __________ syndrome, hardware failure, PE (DVT, ___ _______)

<p><strong>Femur Shaft Fracture: Treatment and Complications</strong></p><p>-Treatment</p><ul><li><p>Initial → __________ if unstable, pain control, immobilization</p></li><li><p>If open fracture, add antibiotics and ________ prophylaxis </p></li><li><p>Ortho consult</p></li></ul><p>-Complications </p><ul><li><p>___________, malunion, delayed union, __________, pain d/t ortho hardware</p></li><li><p>_____________, neurovascular injury, __________ syndrome, hardware failure, PE (DVT, ___ _______) </p></li></ul><p></p>
18
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posterior, flexed, external, extended, acetabulum, knee

Hip Dislocation: Background

-Types

  • ___________ is most common

  • Anterior

  • Inferior

-Mechanism of Injury

  • Posterior → significant force on ______ hip and knee

  • Anterior → forced ________ rotation of an __________ hip

-Commonly associated with fractures of the __________, femur, or ____

<p><strong>Hip Dislocation: Background</strong></p><p>-Types</p><ul><li><p>___________ is most common</p></li><li><p>Anterior</p></li><li><p>Inferior</p></li></ul><p>-Mechanism of Injury</p><ul><li><p>Posterior → significant force on ______ hip and knee</p></li><li><p>Anterior → forced ________ rotation of an __________ hip</p></li></ul><p>-Commonly associated with fractures of the __________, femur, or ____</p>
19
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severe, decreased, shortened, internally, adducted, abducted, externally, CT/MRI

Hip Dislocation: S/S and Diagnosis

-S/S

  • _______ hip pain and __________ ROM

  • Posterior → _________, ________ rotated, ___________, flexed extremity

  • Anterior → ___________, _________ rotated, slightly flexed extremity

-Diagnosis

  • Xray is the initial imaging

  • __/___ are for definitive diagnosis

<p><strong>Hip Dislocation: S/S and Diagnosis</strong></p><p>-S/S</p><ul><li><p>_______ hip pain and __________ ROM</p></li><li><p>Posterior → _________, ________ rotated, ___________, flexed extremity </p></li><li><p>Anterior → ___________, _________ rotated, slightly flexed extremity </p></li></ul><p>-Diagnosis</p><ul><li><p>Xray is the initial imaging</p></li><li><p>__/___ are for definitive diagnosis </p></li></ul><p></p>
20
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closed reduction, films, fracture, ortho, arthritis, femoral

Hip Dislocation

-Treatment

  • Immediate _______ ___________ with post-reduction _____

  • Be sure to rule out femoral __________ before attempting reduction

  • _____ consult

-Complications

  • __________ and AVN

  • Sciatic or ________ (anterior) nerve injury

21
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gluteus, tendinopathy, female, scoliosis, repetitive, walking

Greater Trochanteric Pain Syndrome: Background

-________ medius or minimus _____________ with or without bursa involvement

-Risk Factors

  • _________, obesity, back/knee/foot pain, ___________, and leg length discrepancy

-Mechanism of Injury

  • __________ overload from ________, stair climbing, or running

<p><strong>Greater Trochanteric Pain Syndrome</strong>: <strong>Background</strong></p><p>-________ medius or minimus _____________ with or without bursa involvement </p><p>-Risk Factors</p><ul><li><p>_________, obesity, back/knee/foot pain, ___________, and leg length discrepancy </p></li></ul><p>-Mechanism of Injury</p><ul><li><p>__________ overload from ________, stair climbing, or running </p></li></ul><p></p>
22
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lateral, greater, activity, preserved, clinical, self limited, NSAIDs, PT

Greater Trochanteric Pain Syndrome: Treatment

-S/S

  • _______ hip pain

  • TTP over ________ trochanter

  • Pain increased with __________

  • ROM is ________

-Diagnosis

  • _______

  • Imaging is reserved for persistent sx or to r/o other conditions

-Treatment

  • Often ____ _________

  • Rest, ice, ________, stretching, __

  • Steroid injection

<p><strong>Greater Trochanteric Pain Syndrome: Treatment</strong></p><p>-S/S</p><ul><li><p>_______ hip pain</p></li><li><p>TTP over ________ trochanter</p></li><li><p>Pain increased with __________</p></li><li><p>ROM is ________</p></li></ul><p>-Diagnosis</p><ul><li><p>_______</p></li><li><p>Imaging is reserved for persistent sx or to r/o other conditions</p></li></ul><p>-Treatment</p><ul><li><p>Often ____ _________</p></li><li><p>Rest, ice, ________, stretching, __</p></li><li><p>Steroid injection</p></li></ul><p></p>
23
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inflammation, viral infection, children, >, pain, absence, afebrile, aspiration, rest

Transient Hip Synovitis

-_____________ of the hip joint usually following a _____ __________ (URI/GI)

-Epidemiology

  • _________ (3-10 y/o)

  • M _ F

-S/S

  • Hip _____ in the __________ of injury/limited hip ROM

-Synovitis vs Septic Arthritis

  • WBC, ESR, CRP, usually normal; ________

  • MRI and/or synovial fluid __________ for definitive diagnosis

-Treatment

  • ____ and NSAIDs, mostly self limiting

24
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flex, extend, fatigue, instability, running, biceps femoris

Hamstring Strain: Background

-Hamstrings

  • Biceps femoris, semitendinosus, semimembranosus

  • ____ knee and ______ hip; some internal/external rotation

-Risk Factors

  • Inadequate warm up, muscle _______, muscle weakness/________, poor biomechanics, and previous injury

-Mechanism of Injury

  • Most occur during high speed _________

  • _____ _______ is the most commonly injured

<p><strong>Hamstring Strain: Background</strong></p><p>-Hamstrings</p><ul><li><p>Biceps femoris, semitendinosus, semimembranosus</p></li><li><p>____ knee and ______ hip; some internal/external rotation</p></li></ul><p>-Risk Factors</p><ul><li><p>Inadequate warm up, muscle _______, muscle weakness/________, poor biomechanics, and previous injury </p></li></ul><p>-Mechanism of Injury </p><ul><li><p>Most occur during high speed _________</p></li><li><p>_____ _______ is the most commonly injured </p></li></ul><p></p>
25
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posterior, popping, straight leg raise, weakness, clinical, avulsion, compression, ortho

Hamstring Strain: S/S, Diagnosis, Treatment

-S/S

  • Sudden ___________ thigh pain

  • _______ sensation

  • TTP over hamstring

  • ± swelling and ecchymosis

  • Pain with ________ ___ ______

  • ± hip extension and knee flexion ___________

-Diagnosis

  • ______, x-ray concerned for ________ fracture or US/MRI if concerned for tear

-Treatment

  • Rest, ice, _____________, NSAIDs, PT

  • _____ consult if there is a fracture or tear

<p><strong>Hamstring Strain: S/S, Diagnosis, Treatment</strong></p><p>-S/S</p><ul><li><p>Sudden ___________ thigh pain</p></li><li><p>_______ sensation</p></li><li><p>TTP over hamstring</p></li><li><p>± swelling and ecchymosis</p></li><li><p>Pain with ________ ___ ______</p></li><li><p>± hip extension and knee flexion ___________</p></li></ul><p>-Diagnosis</p><ul><li><p>______, x-ray concerned for ________ fracture or US/MRI if concerned for tear </p></li></ul><p>-Treatment </p><ul><li><p>Rest, ice, _____________, NSAIDs, PT</p></li><li><p>_____ consult if there is a fracture or tear</p></li></ul><p></p>