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Fracture Care
- X-ray is initial study of choice and is usually enough to diagnose the fracture
- CT scan may be used for intra articular fractures or fractures which are difficult to see on plain film
- MRI may be used in the case of an occult fracture
- Open fractures should undergo irrigation and debridement within 8 hours of injury. They should also receive a first generation cephalosporin empirically. You may also add an aminoglycoside.
- Treatment for fractures
- Anatomical reduction either open or closed
- Immobilization
- Internal fixation with plates and screws or other hardware may be required if reduction is unstable or fracture is intra-articular.
Disorders of the Hip
Avascular necrosis of the femoral head
- Avascular = no blood, necrosis = death
- This is the death of the femoral head leading to destruction of the joint surface
- Risk factors
- Long term steroid use
- Alcoholism – Liver disease or Pancreatitis
- Trauma
- Arterial embolism
- Sickle cell anemia
- Autoimmune disorders like lupus or rheumatoid arthritis
Clinical Presentation
- Groin pain
- Difficulty walking
Labs, Studies and Physical Exam Findings
- X-ray
- MRI
Treatment
- Core decompression
- Total hip replacement
Developmental Dysplasia of the Hip
- Previously known as congenital hip dislocation
- This is a spectrum of issues related to abnormal development of the hip joint
- These occur mostly in otherwise healthy children
Clinical Presentation
- Routine physical exam
- Gait issues as a toddler
Labs, Studies and Physical Exam Findings
- Children should be assessed for instability as early as possible and up until they are walking normally
- Barlow maneuver – Begin by flexing the hips and knees to 90 degrees. Adduct and internally rotate the hips while applying pressure to the knees in an effort to dislocate the hips( Flexion and internal rotation of the hip is the easiest way to dislocate a hip)
- Ortolani maneuver – This is reducing the hip after it has been dislocated using Barlow maneuver. A clunk as the joint is reduced proves that the Barlow test was positive. This is performed by flexing the hips and knees to 90 degrees and externally rotating the hips while applying pressure over the greater trochanters.
- Limb length discrepancy
- Uneven gluteal folds
- X-ray
- Ultrasound
Treatment
- Bracing and splinting
Fractures & Dislocations of the Hip
- Proximal femur fracture
- Most frequently this is a pathologic fracture with osteoporosis being the most common primary cause.
Clinical Presentation
- I fell and I can’t get up
Labs, Studies and Physical Exam Findings
- Injured leg is short and externally rotated
- X-ray showing the fracture hip
- MRI if x-ray is inconclusive and you suspect a hip fracture
Treatment
- Surgical repair of the fracture
- Often a hemiarthroplasty
- Post op be alert of sciatic nerve complaints
Slipped Capital Femoral Epiphysis (SCFE)
- Caused by a weakness in the proximal physis of the femur
- The epiphysis of the proximal femur slips. The epiphysis stays in the acetabulum and the femoral neck displaced anteriorly.
- 11-13 year old active overweight boys are the most common patients
Clinical Presentation
- My son has been complaining of groin pain for the past few months
- My son has been complaining of knee pain and limping a little for the past few months
Labs, Studies and Physical Exam Findings
- Patient prefers the hip be externally rotated
- Decrease in hip internal rotation, abduction and flexion
- X-ray AP and frog leg
- “Ice cream fell off the cone”
Treatment
- Surgical correction – consider bilateral
