HIP

Femoral shaft fractures

high impact injury

complications: shock, fat embolus, DVT, infection

fat embolism sx:

  • ⬆ RR, ⬆ HR, ⬇ O2, fever
  • petechial rash
  • confusion, retinal haemorrhages, intra-arterial fat globules on fundoscopy

HIP DISLOCATION

POSTERIOR

ANTERIOR

MORE COMMON 🏁

in RTA when knee strikes the dashboard

leg shortening
🚩adduction & internal rotation

sciatic nerve damage
superior gluteal nerve

NoF

RISK:

  • smoking
  • excess alcohol
  • OP
  • maternal hx

hip capsule attached to intertrochanteric line

INTRACAPSULAR

EXTRACAPSULAR

supcapital

transcervical

MOST COMMON 🏁

intertrochanteric

subtrochanteric

shortened and EXTERNALLY rotated

MX: hemiarthroplasty

replaces femoral head only (leaving acetabulum in place)
avoids avascular necrosis

allows immediate weight bearing ❗

MX: dynamic hip screw

weight bearing in 2-3 days

if:

  • reverse oblique
  • transverse
  • subtrochanteric

intramedullary device

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shenton's line 🏁

TRENDELENBERG TEST

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causes

non-union of NOF

RA/OA

NOF fracture

nerve damage

hip dislocation

THOMAS' TEST

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fixed flexion defofmity

OA

previous NOF fracture

can look similar to fracture i.e. abducted and externally rotated

infection - iliopsoas abscess
staph aureus

psoas abscess

psoas T12-L5

lesser trochanter of femur

can spread from IBD/pyelonephritis

HIP IN CHILDREN SUMMARY

transient synovitis

no trauma

recent viral infection

developmental dysplasia of the hip

shallow acetabulum

Galeazzi test

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if presents in adult --> Trenedelnburg gait

MX: pavlik harness

surgery
especially if older

Perthes' disease
aka Legg-calve-perthes disease

osteochondritis of the femoral head

boys, 4-8 yo

premature OA

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slipped upper femoral epiphysis

fat boys 12-14yo

epiphyseal plate fails to grow - dehisensce

avascular necrosis

premature OA

external rotation + shortened

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obturator nerve damage

damage of superior gluteal nerve

can put hip screw, IM nail

bisphosphonates and malignancy

displaced or undisplaced?

undisplaced = cannulated screw

displaced

young?

cannulated screw as cannot put metalwork in them as it will rot

OLD

normal cognition, <=1 walking aid, no significant morbidity

THR

DISLOCATED OFTEN

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meralgia paraesthetica - lateral cutaneous nerve of the thigh as it passes under inguinal ligament