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
shenton's line 🏁
TRENDELENBERG TEST
causes
non-union of NOF
RA/OA
NOF fracture
nerve damage
hip dislocation
THOMAS' TEST
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
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
slipped upper femoral epiphysis
fat boys 12-14yo
epiphyseal plate fails to grow - dehisensce
avascular necrosis
premature OA
external rotation + shortened
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
meralgia paraesthetica - lateral cutaneous nerve of the thigh as it passes under inguinal ligament