Orthopedics
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| Hip Exam: Hx | Trauma, OA, infection
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| Hip Exam: Inspection | Gait; Scars; Swelling
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| Hip Exam: Palpation | Iliopsoas bursa; Gr trochanter/ bursa; Ant iliac spine; Ischial tuberosity/ bursa
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| Hip Exam: ROM / Strength | Hip flex/ ext; Abd/ addn; Int / ext rotation; resisted ROM for strength
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| Gait Analysis: Width of the gait: | Normal =2-4 in heel to heel; Wide based gaits = instability
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| Gait Analysis: Ctr of gravity: | Normal gait oscillates no more than 2 in. vertically; pain & mx weakness => pt shifts COG over affected hip
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| Gait Analysis: Knee position: | S/B flexed in all phases of stance ex. heel strike; pt hikes up affected leg or swings it out & around to front
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| Gait Analysis: Pelvic shift: | pelvis & trunk shift laterally 1 in. to wt bearing side
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| Gait Analysis: Pelvic shift: in gluteus mx weakness: | lateral shift is accentuated to the side involved
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| Gait Analysis: Length of step: | Ave length is 15 in. With age/ fatigue/ pathology: step is shortened
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| Gait Analysis: Cadence: | Ave cadence is 90-120 steps/ min. With age/ fatigue/ pain: cadence is decreased to conserve energy
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| Gait Analysis: Pelvic rotation: | Normal during swing phase = 40 degrees in leg that is moving forward; if pain or stiffness in hip, pelvis will not rotate normally
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| Antalgic gait: | Limp from pain
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| Wide based gait = | Instability from cerebellar disease or peripheral neuropathy
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| Steppage gait = | Weak ankle dorsiflexors results in increase knee & hip flexion
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| Flat foot gait = | Gastrocnemius/ Soleus weakness (S1-S2 radiculopathy)
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| Back Knee gait = | Quadriceps weakness forces pt to push on thigh w/ hand to try to lock knee in stance phase
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| Trendelenberg (abduction lurch) gait = | Gluteus medius weakness (L5); pt lurches toward weak side to place COG over hip
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| Extensor lurch = | Gluteus max weakness (S1); pt thrusts thorax posteriorly to maintain hip extension
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| Foot Drop = | Weakness of tibialis anterior (L4)
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| Pelvic Films: Pelvic ring fx is commonly: | disrupted in 2 places
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| Pelvic Films: AP view: Inspect: | inner & outer main ring cortices; 2 small obturator rings; acetabulum for step off; SI joint spaces s/b equal; symph pubis should align, < 5mm joint space
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| Pelvic Films: CT if: | fx identified or suspected
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| High energy pelvis fx assoc with: | organ & vascular laceration
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| Hip Films: Order: | AP pelvis w/ both hip joints; Lateral of affected hip
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| Hip Films: Femoral Neck | Smooth cortex w/ no buckle, step or ridge; Normal trabecular pattern; No transverse sclerotic lines
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| Hip Films: Intertrochanteric Region | Cf to other hip; No lucency across the bone; No cortical defect
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| Hip fx: prevalence | 90% in > 65 y.o. pt
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| Hip fx: Sx: | Pain, shorter, rotated leg
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| Hip fx: Causes: | Falls, MVA
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| Hip fx: Risk factors: | Age, sex, nutrition, meds
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| Hip fx: Complications: | PE, pneumonia
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| Femoral neck fx & hip dislocations prone to: | AVN
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| Hip fx: Rx: | Screws, partial or total hip replacement
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| Hip fx: Prevention: | Calcium, activity, exercise, safety
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| Femoral Neck fx: Garden type I | Incomplete fx w/ valgus impaction; ORIF
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| Femoral Neck fx: Garden type II | Complete fx w/o displacement; ORIF
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| Femoral Neck fx: Garden type III | Complete fx / partial displacement; Prosthetic replacement
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| Femoral Neck fx: Garden type IV | Complete fx w/ total displacement; Prosthetic replacement
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| Femur fx: tx: Femoral neck | ORIF
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| Femur fx: tx: Intertrochanteric | ORIF
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| Femur fx: tx: Subtrochanteric | Open or closed reduction; Interlocking nail or screw
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| Femur fx: tx: Femoral shaft | Closed reduction & Nail
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| Femur fx: tx: Distal Femur | ORIF with plate & screws
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| Femoral Stress fx: prevalence | Thin, female endurance athletes (AAO)
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| Femoral Stress fx: Sx | Groin pain with running, progressing to ADL pain
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| Femoral Stress fx: PE: | Pain limits extremes of int. & ext. rotation
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| Femoral Stress fx: Dx: | Xray may be negative; Bone scan pos in 2-8 days
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| Femoral Stress fx: most common area = | Femoral neck
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| Femoral Stress fx: Rx: All displaced fx: | ORIF
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| Femoral Stress fx: Rx: Non displaced medial fx: | NWBA 6-8 weeks
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| Femoral Stress fx: Rx: All lateral fx: | ORIF
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| Hip Dislocation: prevalence | 90% are posterior
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| Hip Dislocation: PE: | hip flexed, adducted & internally rotated
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| Hip Dislocation: Dx/ tx: | Xray, pain relief, reduction; Poss N/V entrapment
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| Hip Dislocation: Allis Maneuver | Anesthesia; Assistant stabilizes pelvis w/ pressure on iliac sp; Gently flex hip to 90; apply progressive traction to extremity; apply adduction/ internal rotation
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| Hip Osteoarthritis: Sx | Achy pain over hip & ant groin; Loss of ROM
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| Hip Osteoarthritis: Xray | Decreased Joint space; Sclerosis; Osteophytes
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| Hip Osteoarthritis: RX | NSAIDs; Intraarticular injection; Hip replacement
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| Pelvic Apophyses = | Separation or widening of apophysis
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| Avulsion fx of Hip: ASIS: MOI | knee flexed & hip hyper-extended
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| Avulsion fx of Hip: ASIS: locus = | origin of Sartorius
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| Avulsion fx of Hip: ASIS: PE: | Pain over ASIS & with resisted hip flexion
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| Avulsion fx of Hip: ASIS: Dx: | Xray may reveal avulsion fx
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| Avulsion fx of Hip: ASIS: Rx: | RICE, progressive wt bearing, splint with knee flexed, ORIF for displaced fx
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| Avulsion fx of Hip: Ischial Tuberosity: locus = | Origin of hamstring
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| Avulsion fx of Hip: Ischial Tuberosity: MOI: | Vigorous hip flexion/ knee extension
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| Avulsion fx of Hip: Ischial Tuberosity: Sx: | Pain in buttock
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| Avulsion fx of Hip: Ischial Tuberosity: PE: | TTP at ischial tuberosity
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| Avulsion fx of Hip: Ischial Tuberosity: Rx: | RICE, progressive wt bearing, ORIF for displace fx
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| Groin Pull: MOI | Forced abduction during fall or collision
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| Groin Pull: Sx | Pain at origin of adductors
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| Groin Pull: PE: | Increased pain on resisted adduction
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| Groin Pull: DDx: | Hernia, torsion
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| Groin Pull: Rx: | Rest, ice, meds, stretching & strengthening
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| Hip Pointer injury: MOI | Direct blow to iliac crest
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| Hip Pointer injury: PE: | Swelling, tenderness, ecchymosis at iliac crest
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| Hip Pointer injury: Dx | Xray to R/O fx
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| Hip Pointer injury: Rx: | Ice, compression, pain meds; Progressive stretching
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| Legg-Calve-Perthes Dz: MOI | Avascular necrosis of the femoral head
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| Legg-Calve-Perthes Dz: prevalence | Child 2-11 y.o.
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| Legg-Calve-Perthes Dz: PE: | Loss of int / ext rotation
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| Legg-Calve-Perthes Dz: Xray = | Mottled femoral head
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| Legg-Calve-Perthes Dz: Rx: | Containment of femoral head with bracing / casting
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| Legg-Calve-Perthes Dz: Outcome: | self limiting, revascularization occurs in some
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| Slipped Capital Femoral Epiphysis: prevalence | Obese, pre-pubescent boys > girls; 40% are bilateral; most are idiopathic
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| Slipped Capital Femoral Epiphysis: Sx | Limp & hip, thigh, or knee pain; loss of IR, flexion, & abduction
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| Slipped Capital Femoral Epiphysis: Rx: | surgical fixation & non wt bearing
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| Snapping Hip Syndrome: MOI | 1: ITB snaps over Gr trochanter; 2: Iliopsoas tendon snaps over ASIS
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| Snapping Hip Syndrome: Sx: | Hip pain worse with activity; Snapping with hip flexion
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| Snapping Hip Syndrome: PE: | Pain with resisted hip flexion; Pain lateral with ITB, anterior with ASIS
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| Snapping Hip Syndrome: Rx: | Ice, meds, activity modification, S&S, injection
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| Trochanteric Bursitis: Sx | Pain over Gr trochanter when moving hip into full flexion; Extreme point tenderness; Pain at night lying on affected side
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| Trochanteric Bursitis: PE: | Moving hip from extension to flexion reproduces pain; poss crepitus over trochanter; TTP over affected greater trochanter
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| Trochanteric Bursitis: Rx: | Hip stretches, meds, injection
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| Transient Hip Synovitis: Sx | Benign, non traumatic, self limiting hip pain; lasts 3-7 days
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| Transient Hip Synovitis: must R/O: | septic hip; Legg-Calve-Perthes
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| Transient Hip Synovitis: Etiology | Inflam immune response to URI; inc synovial fluid in hip joint causing pain
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| Transient Hip Synovitis: PE: | Painful ROM; Joint held in flex, abd & ext rotation
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| Transient Hip Synovitis: Xray: | Capsular swelling
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| Transient Hip Synovitis: Lab: | WBC & ESR normal; Joint fluid aspiration is normal
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| Meralgia Paresthetica = | Lateral femoral cutaneous n. entrapment; Exits pelvis near ASIS
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| Meralgia Paresthetica: Sx: | Pain & burning over lateral thigh
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| Meralgia Paresthetica: Etiology: | Obesity, tight clothing, repetitive trauma/ activity
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| Meralgia Paresthetica: Rx: | Correct offending source; pain relief; chronic pain may need injection or surgical release
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| DDH = | developmental dysplasia of the hip
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| Hip Pain: Other Causes | DDH (Peds); Tumor; Osteosarcoma; Ewing; Metastatic dz; Multi myeloma
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| Positive Faber test suggests: | hip disease, iliopsoas spasm, or sacroiliac disease
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| Hip pain exam: | inspect, gait, palpate, Faber, SLR, pulses
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| Hip dx tests: | wt bearing xray; bone scan if suspect fx/necrosis; MRI TOC for fx not seen in xray, and necrosis/ infxn/tumor; u/s for kids effusion
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| osteonecrosis | Groin pain (less often thigh / buttock pain) = femoral head dz. Wt-bearing & pain w/motion, possibly rest/night pain; RF: steroids; dx: MRI sens > xray/scan
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| severe anterolateral hip tenderness, severe pain w/wt bearing, intolerance to passive hip rotation; xray normal (dx w/MRI) = | occult hip fx (nondisplaced fx of femoral neck)
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| Hip pain DDx | hip dysplasia; nerve entrapment; ankyl spondylosis; RA; lumbar disk pathology
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| Idiopathic AVN of femoral head; painless limp | L-C-P dz (3-12 yo, M>F); tx abduction bracing
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| High energy pelvis fx is often associated with: | organ & vascular laceration
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| Hip fx: prevalence | 90% in > 65 y.o. pt
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| Hip fx: Sx: | Pain, shorter, rotated leg
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| Hip fx: Complications: | PE, pneumonia; Femoral neck fx & hip dislocations prone to AVN
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| Femoral Stress fx: prevalence | Thin, female endurance athletes (AAO)
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| Femoral Stress fx: Sx | Groin pain with running, progressing to ADL pain
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| Femoral Stress fx: Dx: | Xray may be negative; Bone scan pos in 2-8 days
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| Femoral Stress fx: most common area = | Femoral neck
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| Femoral Stress fx: Rx: All displaced fx: | ORIF
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| Femoral Stress fx: Rx: Non displaced medial fx: | NWBA 6-8 weeks
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| Femoral Stress fx: Rx: All lateral fx: | ORIF
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| Hip Dislocation: prevalence | 90% are posterior
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| Hip Dislocation: PE: | hip flexed, adducted & internally rotated
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| Hip Dislocation: Allis Maneuver | Anesthesia; Assistant stabilizes pelvis w/ pressure on iliac sp; Gently flex hip to 90; apply progressive traction to extremity; apply adduction/ internal rotation
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| Hip Osteoarthritis: RX | NSAIDs; Intraarticular injection; Hip replacement
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| Avulsion fx of Hip: Ischial Tuberosity: MOI: | Vigorous hip flexion/ knee extension
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| Hip Pointer injury: MOI | Direct blow to iliac crest
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| Legg-Calve-Perthes Dz: Sx | Insidious groin/ thigh pain; Limp; Loss of int / ext rotation
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| Snapping Hip Syndrome: MOI | 1: ITB snaps over Gr trochanter; 2: Iliopsoas tendon snaps over ASIS
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| Snapping Hip Syndrome: PE: | Pain with resisted hip flexion; Pain lateral with ITB, anterior with ASIS
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| Trochanteric Bursitis: Sx | Pain over Gr trochanter when moving hip into full flexion; Extreme point tenderness; Pain at night lying on affected side; poss crepitus over trochanter
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| Trochanteric Bursitis: Rx: | Hip stretches, meds, injection
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| Meralgia Paresthetica = | Lateral femoral cutaneous n. entrapment; Exits pelvis near ASIS
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| Meralgia Paresthetica: Sx: | Pain & burning over lateral thigh
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| DDH = | developmental dysplasia of the hip
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| Hip Pain: Other Causes | DDH (Peds); Tumor; Osteosarcoma; Ewing; Metastatic dz; Multi myeloma
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| Displacement of proximal femoral epiphysis due to disruption of growth plate = | SCFE
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