pelvis and hip fractures and conditions

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Pelvis and hip
for beginners
Duane Anderson, MD
February 2020

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What will be the topics?
 Trauma
 Spontaneous hip pain

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Historical Perspective: Pennal & Tile
 AP, Inlet, and Outlet Pelvic Radiographs

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Historical Perspective: Pennal & Tile
 AP, Inlet, and Outlet Pelvic Radiographs
 Best for: posterior displacement & internal/external rotation deformity

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Pelvis injuries
 Severe trauma
 Vascular injury
 Urethral injury
 Neurologic injury
 Rectal injury

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Young Burgess
and Tile

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Acetabular fractures

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Acetabular fracture x-ray views

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Hip fracture types

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Xray views,
AP pelvis and lateral hip

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After minor trauma of the hip
 Persistent groin pain in the elderly with nl xrays
 Consider a CT

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Spontaneous hip pain in children
 Slipped Femoral Epiphysis
 Calve-Legg-Perthes disease
 Psoas abscess
 Septic arthritis of the hip
 TB of the hip

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Infection of the hip
 Onset slow or rapid, TB vs bacteria
 CBC, ESR, Temp, CRP quantitative
 Plain x-rays likely nl depending on length of time
 US essential in diagnosis
 Physical exam

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Physical exam
psoas abscess
 Able to ambulate
 Walks hunched over
 Doesn’t like hip extension
 Rotation of the hip is not bothersome
 US of the hip AND pelvis gets you the diagnosis

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PSOAS ABCESS

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Physical exam
TB of the hip
 Able to ambulate
 Doesn’t like hip extension
 Hip rotation is painful at extremes
 US is positive for fluid in the hip
 X-RAY NL EARLY ON

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Physical exam of the hip
septic arthritis
 Unable to ambulate
 Painful motion in any direction
 Fluid in the hip joint

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Calve-Legg-Perthes of the hip
 Spontaneous pain in a 5-10
year old
 Painful limp, usually unilateral
 Lacks rotation

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Slipped Femoral Ephiphysis
 Spontaneous pain usually
unilateral
 Age 10-13

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Spontaneous pain in an adult
 Back related
 Sacroiliac
 Trochanteric bursitis
 Avascular necrosis
 Osteoarthritis
 TB of the hip
 Hip impingement

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Hip pain related to the spine
 Felt in the buttock
 Tender in the spine, SI joint,
buttock
 Spine x-rays may or may not
be positive
 Piriformis syndrome= buttock
pain as well but rare

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Sacroiliac pain
 Tender in the SI joint area
 Ankylosing Spondylitis
 FABER test is positive

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FABER OR PATRICK’S TEST
 FLEXION
 ABDUCTION
 EXTERNAL ROTATION
 F AB ER

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Trochanteric Bursitis
 Lateral hip pain
 Painful to lay on that side
 Nl hip x-rays
 Tender to direct palpation over
the hip
 Nl hip exam except painful
 Responds to cortisone shot
 Inject with the hip passively
abducted to create more space

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AVN
 Spontaneous pain in the groin
 HIV
 Steroids
 Idiopathic
 Can have nl x-rays
 Early diagnosis by MRI
 Trendelenburg gait or antalgic
gait

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AVN

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Osteoarthritis of the hip
 Spontaneous groin pain
 May have nl x-rays early on
 Loss of rotation of the hip
 Trendelenburg gait
 Causes include acetabular
abnormal development,
impingement, old age
 Loss of motion in all directions as
disease progresses
 Painful rotation early on

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TB of the hip
 Spontaneous groin pain
 Able to ambulate
 NL x-rays
 Elevated ESR most of the time
 Limited motion
 HIGH index of suspicion
 US of the HIP, aspiration, biopsy
 Drug treatment!
 Erosions on both sides of the joint is
characteristic of late TB

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Hip impingement
 Cause of much of osteoarthritis of
the hip
 Pain in 20-30 year old, especially
athletes
 Both femoral and acetabular
abnormalities alone or combined
 Early on painful flexion and
internal rotation
 X-rays are abnormal to the trained
eye

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PincerCam

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Hip impingement sign
 Pain with prolonged sitting in
the groin
 Worse with more hip flexion
 Pain with flexion and IR

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Rotation prone

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FEMORAL STRETCH OR ELY TEST
 SHORTENED RECTUS
FEMORUS
 IF NO LIFT OFF BUT
PAINFUL= FEMORAL
NERVE IRRITATION OR
PROXIMAL LUMBAR
HERNIATED DISC

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HIP FLEXION CONTRACTURE
STAHELI TEST THOMAS TEST