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

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