LE Orthopedic Conditions

Bleeding

most common complication of pelvic fracture.

Sartorius

muscle responsible for avulsion fracture of ASIS.

Rectus Femoris

muscle responsible for avulsion fracture of AIIS.

Avascular Necrosis

most common complication of femoral neck fracture.

Duverney’s Fracture

- isolated iliac wing fracture

- stable fracture

Malgaigne Fracture

- double vertical fracture of anterior and posterior pelvic ring

- unstable fracture

Hamstrings

muscle responsible for avulsion fracture of ischial tuberosity.

Avulsion Fracture

traction apophysitis secondary to forceful muscle contraction.

Osteitis Pubis

- inflammation of symphysis pubis

- causes:

• pregnancy

• overactivity of hip adductors

• motor bikers

• gymnast

- signs and symptoms

• burning groin pain

• dull, aching pain to sharp stabbing pain

• (+) moth eaten appearance in x-ray

• tightness of hip adductors

• weakness of hip abductors

Symphysis Pubis Dysfunction

- lax ligament

- pain in the pubic area aggravated by stepping fown from a curb

- poor spinal stabilizing muscles

- overactive adductors; underactive abductors

Diastasis Symphysis Pubis

widening or separation of the pubic symphysis due to a ruptured ligament.

Multiple Myeloma

- cancer that started in the bone marrow

- overproduction of abnormal plasma cells

- signs and symptoms:

• noctural nagging pain

• (+) mickey mouse lesion

Innominate

most common site of metastasis of multiple myeloma.

Hip Pointer

contusion to ASIS due to direct trauma.

Anterior Innominate Syndrome

- one innominate rotates anteriorly in relation to the other

- etiology: attributed to tight quadriceps or illiopsoas muscles

- supine: affected leg longer

- sitting: affected leg shorter

Posterior Innominate Syndrome

- one innominate rotates posteriorly in relation to the other

- etiology: attributed to tight hamstrings

- supine: affected leg shorter

- sitting: affected leg longer

Supine to sit test

special test for innominate syndrome.

Ischiogluteal Bursitis

- direct trauma to buttocks

- prolonged sitting on hard surface

- “boatman’s/tailor’s/weaver’s bottom

Slipped Capital Femoral Epiphysis

- downard slippage of femoral head from growth plate

- most common hip pathology in adolescents

- tall and obese; M > F

- signs and symptoms:

• abduction with IR

• presents with hip flexion and ER

• pain on lateral hip

• trendelenburg/waddling gait

- management: fixation using pins/screw

Legg Calve Perthes Disease

- avascular necrosis of the femoral head in children (coxa plana)

- short and thin, 7 y/o ; M > F

- signs and symptoms:

• abduction and IR

• pain on groin or thigh

• psoatic gait

• Toronto (ABIR)

• Trilateral (ABIR)

• Scottish Rite (FAB) - most commonly used

orthosis for LCPD.

I - necrosis

II - fragmentation

III - reossification

IV - healing

waldenstrom stages of LCPD.

Coxa Magna

enlarged femoral head.

Coxa Breva

short broad femoral neck.

Congenital Hip Dislocation

- dislocated at birth

- special test: Ortolani’s Test

Congenital Dislocatable Hip

- intact at birth, but unstable or dislocatable

- special test: Barlow’s Test

Congenital Subluxable Hip

- intact at birth but subluxable

- partial hip dislocation due to lax ligaments

Teratologic Hip Dislocation

- fixed hip dislocation prenatally

- arthrogryposis multiplex congenital

Acetabular Dysplasia

- absent condyloid ligament

- shallow hip socket

• Von Rosen (FAB)

• Ilfeld (FAB)

• Pavlik Harness (FABER) - most common

orthosis for congenital hip dislocation.

Falls

cause of acquired hip dislocation in elderly.

Motor Vehicular Accident

cause of aacquired hip dislocation in young people.

Cemented Fixation

- fixation used for the elderly and sedentary

- made up of polymethylmethacrylate

- weight bearing is tolerated <24 hrs

Non-cemented Fixation

- fixation used for young, active patients

- made up of porous coating

- weight bearing is limited up to 3 months

• Hip flexion >90°

• Adduction over the midline

• Internal rotation beyond neutral

THR posterolateral approach precautions.

• Hip flexion >90°

• Combined FABER

• Hip extension, adduction, ER beyoud neutral

THR anterolateral approach precaution.

• Adduction past neutral

• No active antigravity abduction for at least 6-8 weeks

THR trangluteal approach precaution.

• Pronated foot

• IR of hip

• Shorter leg

• Anterior pelvic tilt

components of coxa vara.

• Posterior pelvic tilt

• I/L leg is longer

• ER of hip

• Supinated foot

components of coxa valga.

• Increase Q angle

• Patella alta

• Genu valgum

• External tibial torsion

• Subtalar pronation

• In-toeing

components of anteversion.

• Decreased Q angle

• Patella baja

• Genu varum

• Internal tibial torsion

• Subtalar supination

• Out-toeing

components of retroversion.

Snapping Hip Syndrome

coxa saltans.

Internal Snapping h