Hip Disorders & Ortho Hodgepodge

PA Study Sesh

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