Next Lesson - Conditions of the Lower Back
- To be able to describe the common conditions of the hip
- To be able describe the presentation of hip conditions
- To be able to describe some secondary complications of hip conditions
The conditions of the hip included in this article are:
- Neck of femur fracture
- Hip dislocation
- Osteoarthritis of the hip
- Injury to superior gluteal nerve
Neck of Femur Fracture
Neck of femur fractures can be divided into two categories – intracapsular and extracapsular.
Intracapsular fractures are more common in women and the elderly. They present with a shortened, abducted and externally rotated leg at the hip. The medial femoral circumflex artery is at risk of injury (this risk is increased if the fracture is displaced) and damage to this artery can cause avascular necrosis to the femoral head. As a result is is vital blood supply is restored to prevent permanent damage to the femoral head. Treatment often involves a full or partial hip replacement especially in the elderly.
Extracapsular fractures are more common in young/middle-aged people. They also present with a shortened, abducted and externally rotated leg at the hip due to the distal fragment being pulled upwards and rotated laterally. Avascular necrosis is very rare in extracapsular fractures because the fracture is distal to the medial femoral circumflex artery.
Diagram - The two main types of femoral neck fractures
Creative commons source by Doctodoc, edited by Laura Hansell [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
Hip dislocations can be divided into two categories – anterior and posterior.
90% of all hip dislocations are posterior and are most commonly caused by the knee impacting on the dashboard in a car accident. They present with a flexed, adducted and internally rotated leg at the hip. Posterior dislocations are often associated with sciatic nerve palsy.
Anterior dislocations a much less common and the mechanism of injury is usually linked to skiing. They present with a flexed, abducted and externally rotated leg at the hip. A femoral nerve palsy may also be present it this is relatively uncommon.
Treatment in both cases is hip reduction (analgesia required) followed by rehabilitation.
Image - An X-ray of a superior hip dislocation
Creative commons source by James Heilman, MD [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
Osteoarthritis of the Hip
Osteroarthritis (OA) of the hip is most common in males over the age of 40 years. It usually presents with joint stiffness; mechanical pain in the hip, gluteal and groin regions that radiates to the knee; and reduced mobility. The primary cause of OA is unknown but it can occur secondarily to trauma, infection, rheumatoid arthritis and metabolic disorders.
First line treatment for OA of the hip is over the counter painkillers and lifestyle changes to increase fitness and lose weight.
Image - Osteoarthritis affecting the hip joint
Creative commons source by CFCF [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
Injury to the Superior Gluteal Nerve
Damage to the superior gluteal nerve typically presents with Trendelenburg’s sign – dropping of the pelvis on the contralateral side to the nerve injury when standing on the leg of the affected side. This occurs as the superior gluteal nerve supplies gluteus medius and gluteus minimus, and the function of these muscles is to stabilise the hip. The patient may use their trunk muscles to compensate when walking causing them to lean to one side, this is called Trendelenburg gait.
Diagram - A positive and a negative Trendelenburg's sign
Creative commons source by Mikael Häggström [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
Reviewed by: Thomas Burnell
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