1. Clinical examination

2.  Ball and socket, Synovial, Multiaxial joint
 Compensations for hip deficits
 Referred pain to knee joint
 Neck shaft angle
 Femoral anteversion
 Arterial supply
 Calcar femorale
 Capsular reflections
 Extension-first movement to be lost
 Joint space- most accomodative in Fl, Abd,ER

3.  Pubic tubercle
 Femoral head
 Femoral neck
 Mid inguinal point
 Mid point of inguinal ligament
 Line joining PSIS

4.  Pain – Night cries
 Limp
 Trauma
 Steroid intake
 Alcohol intake
 Tuberculosis
 Bronchial asthma
 Complaint during childhood

5.  Gait
 Trendelenberg’s gait-DDH
 Short limb gait
 Antalgic gait-OA hip
 Waddling gait-osteomalacia
 High stepping gait-foot drop
 Scissors gait-cerebral diplegia

6.  DDH-wide perinium
 Synovitis-Flex.,Abd.,ER.,App. lenthening
 Arthritis-Flex., Add.,IR.,+/- True shortening
 Posterior dislocation-Flex.,Add.,IR.,True and
App. shortening
 Anterior dislocation-Flex.,Abd.,ER.,App.
lenthening
 Fracture trochanter-Marked ER
 Fracture neck of femur-ER-not so marked-
capsular catch

7.  Skin
 Exagerrated lumbar lordosis
 Level of ASIS
 Wasting
 Shortening/Lengthening
 Soft tissue
 Bony points
 Swelling

8.  To confirm the findings of inspection
 Temperature
 Tenderness-Ant/Post/Lat/Med/Iliac fossa
 Bony prominences/Greater trochanter
 Sites to be palpated for psoas abscess

9. NARATH’S SIGN
Femoral arterial pulsations
Positive in
Post. dislocation of hip
Excised or dissolved head and neck
Burger’s disease
Lymph nodes-Inguinal and External iliac

10. Flexion 0-110/130 Psoas major Rectus
femoris,Sartorius,Pecti
nius,TFL,Adductors
Ext 0-20 Gl.max.,Gl.med.,Semi
tendinosis,Semimembr
anous,Biceps femoris
Abd. 0-45/55 Gl.Med. Gl.min.,TFL,Gl.max.
Add. 0-35/45 Adductors,Pectinius
Grasilis
0-40/50 Obt.ext.,internus,Quad
.femoris,Piriformis, Sartorius,Long head of
Gamelli biceps
0-30/40 Gl.med,semitendinosu
Gl.min,TFL
s,Semimembranous

11.  Flexion

12.  Extension

13.  Rotation

14.  Abduction Adduction

15.  Line joining two ASIS cuts midline at right
angle
 Fallacies-Not possible in fixed scoliosis
due to fixed obliquity of pelvis
 Iatrogenic-ASIS removed for bone grafting
 Mal or ill development of hemipelvis e.g.
residual polio myelitis
 Unreduced dislocation of SI joint
 Malunited or unreduced verticle fracture
of ilium

16.  Position from where limb can’t be brought back
to neutral position but further movement in
same axis is possible
 Causes-Persistent muscular spasm
 Persistent posture to avoid pain or to conceal
deformity
 Disparity of limb lengths
 Destructive changes in joint
 Fibrotic contractures in periarticular soft tissues
 Surgical interventions

17.  To conceal deformity
 To maintain equilibrium by shifting centre of
gravity
 To apparently make up the disparity of limb
lengths
 To stabilise the unstable hip
 To assess fixed deformity it is essential to
neutralise compensatory mechanisms

18.  Exagerrated lumbar lordosis
 Thomas test-Hugh Owen Thomas 1876

19.  Critisism-Patient is hurt further in painful hip
 Obese or heavily built individuals
 Bilateral FFDs
 Ankylosed knee
 Inappropriate force for flexion
 Alternative method-Prone position-
Bilat.cases/FFD knee

20.  Fixed abduction-ASIS at
lower level
 Scoliosis with covexity on
affected side
 1cm of true shortening-10
degree of fixed abd.
 Fixed add.-ASIS at higher
level
 Scoliosis with convexity to
unaffected side

21.  Kothari’s angle
 Rotational deformities
are usually revealed due
to lack of compensation

22.  Shortening compensated by-Pelvic tilt,Ankle
equinus,Flexion of opposite hip and knee
 Apparent measurement-To assess extent of natural
compensation
 Pre requisites-Supine with affected limb in line with trunk
 Both lower limbs in parallel position
 Supratsernal notch /Xiphisternum to medial malleolus

23.  From ASIS to medial malleolus
 Pre requisites-Square the pelvis
 Both lower limbs in parallel positions
 True=App. No compensation
 True>App. Part of shortening
compensated(Abd. Defo.)
 True<App. Add. Defo.+ shortening
without compensation

24.  Leg-Central point on medial joint line to tip of med.
Malleolus
 Thigh-Supratrochanteric- neck and head -Bryant’s triangle
 Infratrochanteric-Tip of gr. Tr. to knee joint line

25.  Shortening of base-riding up of tr.,shortening in
head neck, dislocation
 Reversed Bryant’s triangle-Gross overriding of
trochanter
 Perpendicular line-Shortening-Post. and central
dislocation
Lengthening-FFD hip,Fracture
trochanter
 Hypotenuse-
Central dislocation of hip
Old fracture neck of femur with neck
absorption
Absence of head due to disease or
surgery

26.  Fallacies of Bryant’s triangle-Bilateral affection
Excision of ASIS e.g. for bone graft
Limb disarticulated at hip
 Lines-Nelaton’s line-Supra trochanteric shortening

27.  Schoemaker’s line-
 DDH, Bilat. Coxa vara
 Chine’s test-Lines
coverge on that side
 Morris’s bitroch. Test-
Tr. Ext. rotated or
displaced back or vice
versa
 Bilateral affe.-Seg.
Meas.
 Circum. Meas. At mid
thigh level

28.  Trendelenberg’s
sign
 Friedrich
Trendelenberg’s
1895
 Fulcrum-DDH
Leverarm- # N/F
Power-Polio
myelitis

29.  Fallacies-
 Intact Quadratus lumborum
 Incoordination of muscles-Cerebral palsy
 Affection of SI joint
 Medial shift of mechanical axis of leg below
hip-bow knee
 Obese and bulky persons

30.  Dislocatable hip
 Adduction and
posterior push
 Relaxed baby
preferably in
mother’s lap

31.  Marino Ortolani
1937
 Dislocated hip
 Abduction and
lifting the
trochanter
 Palpable clunk

32.  To calculate femoral anteversion

33.  Non union fracture
neck of femur
 Old unreduced
posterior dislocation
 Paralytic hip

34.  Hip-60 degree
 Knee-90 degree
 Foot planted over bed
 Tibial shortening Femoral shortening

35.  IT band contracture
 Hip abducted knee
flexed 90
 Polio myelitis
Meningomyelocele

36.  Flexion
 Abduction
 External rotation
 Extension

37.  Hart’s sign-Limitation of abduction
 Klisick’s sign
 Asymmetrical gluteal folds-Pelvic obliquity
-Limb length
discrepancy
- Muscular atrophy
 Ortolani’s and Barlow’s tests

38. 
THAN X