Acetabular Rim Fracture Research Articles

Computed tomography of the equine caudal spine and pelvis. Pathological findings in 56 clinical cases (2018-2023).

Computed tomography (CT) of the axial skeleton is increasing across many equine hospitals. CT of the pelvis and caudal spine in a large group of clinical cases has not been reported previously. To describe the pathological lesions identified in the caudal spine/pelvis in horses and ponies undergoing CT spine of this region. A retrospective case series. Horses with CT imaging of the caudal spine/pelvis were included. Horses aged under 6 months and those with CT examinations performed post-mortem were excluded. Fifty-six horses met the inclusion criteria. Ages ranged from 8 months to 20 years and bodyweights from 85 to 680 kg (mean 488 kg). Horses presented predominantly for lameness (30/56) and poor performance (18/56). Osseous pathology was identified in 41/56 horses; including osteoarthritis of the sacroiliac joint(s) (n: 28), pathology of the intervertebral disc joint(s) (n: 12), pelvic fractures (n: 9), osteoarthritis of the coxofemoral joint(s) (n: 8), ventral spondylosis (n: 6), acetabular rim fracture (n: 2), dislocation of coxofemoral joint(s) (n: 2), and dorsal dermal sinus of the sacrum (n: 1). The relationship between CT imaging findings and clinical signs in horses remains unclear. Further work is required to describe the relationship between congenital, developmental, and acquired changes in the caudal spine and pelvis, and clinical signs. CT of the caudal spine and pelvis can be utilised in horses and ponies for diagnosing a range of clinical disorders that may be causing 'lumbosacroiliac pain', poor performance, hindlimb lameness, and stiffness. The pathologies we observed were diverse and many patients had multiple lesions.

Intermediate to Long-Term Results Following Traumatic Hip Dislocation: Characteristics, CT-Based Analysis, and Patient-Reported Outcome Measures.

Traumatic hip dislocation is a rare yet severe injury. As the long-term morbidity, subsequent complications, and clinical outcomes are nearly unknown, we aimed to analyze traumatic hip dislocations and identify specific factors that may predict the clinical outcome. Data on injury-related characteristics and computed tomographic (CT) scans for all consecutive adult patients who had been managed for traumatic hip dislocation between 2009 and 2021 were analyzed. At the time of follow-up, the patients were assessed with regard to osteonecrosis, posttraumatic osteoarthritis (OA), further operations and complications, return to sports and work, and patient-reported outcome measures (PROMs), including the Tegner Activity Scale and modified Harris hip score. One hundred and twelve patients (mean age [and standard deviation], 43.12 ± 16.6 years) were included. Associated acetabular rim and femoral head fractures (Pipkin Type I to IV) were observed in 44% and 40% of patients, respectively. Concomitant injuries occurred in 67% of the patients, most commonly involving the knee (29% of patients). Sixty-nine patients (61.6%) were available for follow-up; the mean duration of follow-up was 6.02 ± 3.76 years. The rates of osteonecrosis and posttraumatic OA were 13% and 31.9%, respectively, and were independent of the timing of hip reduction, leading to subsequent total hip arthroplasty (THA) in 19% of patients. Sciatic nerve injury occurred in 27.5% of the patients who were available for follow-up. Both THA and sciatic nerve injury were associated with posterior acetabular rim or Pipkin Type-IV fractures (p < 0.001). Only 33.3% of the patients returned to their pre-injury level of sports, 24.6% did not return to work, and 27.5% reported having sexual dysfunction. PROMs (Tegner Activity Scale, modified Harris hip score) were significantly worse in patients with osteonecrosis, posttraumatic OA, or residual sciatic nerve injury (p < 0.05). Traumatic hip dislocations are predominantly associated with Pipkin and acetabular rim fractures, leading to overall limitations of activities of daily living, sports, and sexual function at intermediate to long-term follow-up. Patients with associated acetabular rim or Pipkin Type-IV fractures are most likely to require THA for the treatment of osteonecrosis or posttraumatic OA and are at greater risk for sustaining sciatic nerve injury. Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Acetabular Rim Fracture after Adult Spinal Deformity Surgery-Induced Secondary Hip Osteoarthritis: Two Case Reports.

Acetabular Rim Fracture after Adult Spinal Deformity Surgery-Induced Secondary Hip Osteoarthritis: Two Case Reports.

Poster 119: MRI evidence of labral tears in healthy young athletes without hip pain

Objectives: The prevalence of labral tears in asymptomatic active adults has been reported, but the prevalence of labral tears and other incidental hip lesions in the asymptomatic adolescent population has not yet been determined. The purpose of this study was to determine the prevalence of hip abnormalities detected on 3T MRI in an active adolescent population with no hip symptoms and, secondarily to compare with hip abnormalities found in adolescents who underwent an MRI for a hip related condition. Methods: Following IRB approval, adolescent patients presenting with isolated knee pain requiring knee MRI were prospectively recruited to have a 3T MRI of their asymptomatic contralateral hip (ASx). A comparison group of adolescent subjects who underwent an MRI for hip pain was enrolled retrospectively (Sx). All MRI scans were anonymized and randomized. Based on preliminary power analysis, 50 subjects were enrolled for each cohort. Blinded to the patient’s cohort status, clinical and demographic data, 2 fellowship-trained musculoskeletal radiologists evaluated these MRI’s independently for abnormal hip lesions, including labral tears. Inter-reader reliability was evaluated using Cohen’s Kappa. A chi-square or Fisher’s exact test was used to compare the prevalence of these hip lesions between the two cohorts. Results: Average patient age was 14.9 years for both cohorts (range 9-18 years); 52% were female. In the ASx group, incidental labral tears were found in 18%, labral/paralabral cysts 6%, cartilage lesion 0%, subchondral cyst 0%, ligamentum teres tear 0%, femoral fibrocystic change 0%, cam lesion 30%, acetabular bone edema 0%, acetabular rim fracture 0%. The prevalence of labral tears (30%, P-value 0.160) and cam lesion (36%, P-value 0.523) in the Sx group was not significantly different from that of the ASx cohort. Conclusions: Labral tears were present on 3T MRI’s of adolescents with and without hip pain. While MRI is essential to confirm the surgeon’s suspicion and to detect unexpected pathology, clinical exam and history are crucial in pinpointing clinically relevant abnormal imaging findings. [Table: see text]

Acetabular Rim Ossification Variants Are Found in Almost 20% of Patients Presenting With Hip Pain

To determine the prevalence of 4 different types of acetabular rim ossifications, including partial labral ossification or punctate calcification, true os acetabuli, acetabular rim stress fracture, and complete labral ossification, and to determine whether different types of periacetabular ossifications are linked to demographic or radiological factors. We retrospectively reviewed the medial records of patients presenting for hip-related complaints at 2 sports medicine practices from September 2007 to December 2009. An anteroposterior radiograph of both hips and a lateral radiograph of each hip was obtained for all patients and reviewed for findings of cam and pincer femoroacetabular impingement, degenerative changes (Tönnis grade), and periacetabular calcifications for both hips. These parameters were also evaluated with respect to symptoms, sex, and age. Four hundred ninety-one consecutive patients (982 hips) presented to 2 orthopaedic surgeons at 2 centers for "hip"-related complaints. There were 223 males and 268 females (age 39 ± 14 years). The overall prevalence of periacetabular calcifications in hips was 17.6%, with 56.6% of calcifications in the symptomatic hip and 43.4% in the contralateral hip. Four basic patterns of calcification were identified: punctuate calcifications within the labrum (8.0% hips), large rounded calcifications (os acetabuli) (4.2% hip), large fragments with a vertical line of the superior-lateral acetabular rim, consistent with healed or non-healed stress fracture (2.0% hips), and complete ossification of the labrum (3.4% hips). Overall, male sex (P= .002), increased lateral center-edge angle (P= .046), and higher Tönnis grade (P < .001) statistically predicted the presence of periacetabular ossification. Punctate calcifications were more prevalent in males (P= .002). Higher Tönnis grade (P=.029) and increased alpha angle (P= .046) were more prevalent with os acetabuli. Younger age (P= .001), male sex (P= .048), increased alpha angle (P= .012), and increased lateral center-edge angle (P < .001) were more prevalent in acetabular rim fractures. No factors were statistically significant at predicting the presence of an ossified labrum. Periacetabular calcifications are not uncommon. Four particular patterns of calcification are identified: punctate labral calcifications (8%), larger rounded calcifications (i.e., os acetabuli) (4.2%), acetabular rim stress fractures (2%), and complete ossification of the labrum (3.4%) for a combined prevalence of 17.6% in patients presenting to an orthopaedic surgeon with "hip"-related complaints. Nearly half were in the asymptomatic hip. Male sex had a higher prevalence of periacetabular calcifications. An increased lateral center edge angle and higher Tönnis grade also had a higher prevalence of periacetabular calcifications. Younger male patients are more likely to have acetabular rim stress fractures. Patients with an increased alpha angle have a higher prevalence of os acetabuli and rim stress fractures. This study aims to identify, quantify, and categorize periacetabular calcifications about the hip. Their clinical relationships and relevance have been discussed, but no study has distinctly categorized the various types and their prevalence. This study provides a framework for identification and categorization.

Open reduction, acetabular and femoral head fixation of Pipkin type IV fracture in an adolescent: A case report

AbstractBACKGROUND Femoral head fracture is extremely rare in adolescent. There are few studies that focus on cases treated of pipkin type IVCASE SUMMARY A 15-year-old male adolescent suffered a serious traffic accident when he was sitting on the front seat of car. Several hours after accident at the local hospital, he diagnosed as posterior dislocation of the right hip with drop foot , and treat closed reduction immobilisation with skin traction. After first operation he transferred to another hospital. Pelvic radiograph computed tomography revealed a head femoral fracture and large acetabular rim fracture. This was diagnosed as a Pipkin type IV acetabular and femoral head fracture with dislocation. An open reduction Inion Freedom bioscrew fixation of head femur and 4.5 cortical screw fixation of acetabular fracture was performed via a Kocher Langenbeck approach. After 1-year follow-up, the patient could walk without aid and participate in physical activities. The X-ray results showed that the fractures healed well with no evidence of complications.CONCLUSION Open reduction, fixation both acetabular and femoral head is an available therapy to treat Pipkin type IV in adolescent

Dual Mobility Cup in Total Hip Replacements

Objective: Prosthetic joint dislocation remains a significant cause of revision following total hip replacement (THR). To prevent this complication, emphasis has been on choosing the optimum surgical approach, accurate implant alignment, bigger femoral head size, and implementing postoperative hip precautions. In the last decade, a newer acetabular design concept; the “Dual Mobility cup” (DM cup) was introduced to reduce the prosthetic dislocation. Although the concept of the use of such a device is well accepted, there remains apprehension regarding its precise indications, the outcome in terms of wear and ability to decrease the incidence of prosthetic dislocation. We reviewed the early results of a particular DM cup design. Materials and Methods: This study shares a single center experience of using a monoblock DM cup (Captiv DM, Evolutis, Briennon, France) in THR. It is a prospective cohort study that looked at indications, handling issues, complications including prosthetic dislocations at 24 months follow-up. Results: We followed up results of uncemented and cemented DM cup used in 129 patients who underwent primary THR or revision THR (RTHR). There was one (1.6%) prosthetic dislocation amongst primary THR and 2 (3%) in the RTHR group. There were handling issues with monoblock uncemented DM cups of occasional improper seating and acetabular rim fracture. Three cases in which revision was performed, were due to component to component impingement and resulted due to inappropriate acetabular version. Conclusion: The use of DM cups while performing THR or RTHR significantly decreased the incidence of instability. While placing DM cups an attempt should be made to maintain the native version of the acetabular cup to decrease the risk of component impingement and instability. Level of Evidence: Level III, therapeutic study.

Arthroscopic Technique for Reduction and Fixation of an Acetabular Rim Fracture

Acetabular rim fractures can accompany patients with femoroacetabular impingement. Frequently, the acetabular rim fracture is excised. However, if the osseous fragment of the acetabular rim fracture is large enough to result in instability, then the acetabular rim fracture should be reduced and secured with internal fixation. The purpose of this technical note was to describe the arthroscopic technique of internal fixation of an acetabular rim fracture.

Arthroscopic Treatment of Acetabular Rim Fracture after Traumatic Posterior Hip Dislocation: A Case Series Study.

ObjectiveTo investigate the clinical and radiographic short‐term results of arthroscopic treatment for posterior labrum tears with an attached bony fragment after traumatic posterior hip dislocation.MethodsBetween July 2014 and May 2019, a consecutive series of nine patients diagnosed with a posterior labrum tear with an attached bony fragment after traumatic posterior hip dislocation were treated by hip arthroscopic techniques. The patients had been injured in traffic accidents (n = 6) or high falls (n = 3). All patients were provided primary treatment at the emergency department of our institution, and then were transferred to our department for arthroscopy. Demographic data (e.g. gender, age, etc), intraoperative findings, the preoperative and postoperative multiple clinical scores and radiological results were subsequently assessed. Visual analogue scale for pain (VAS) and modified Harris hip scores (mHHSs) were measured and compared before surgery, and at the last follow‐up.ResultsA total of nine patients were enrolled, all of them were male, with a mean age at surgery of 32.2 ± 5.6 years (range, 22–65 years). The patients were followed‐up for an average of 26.5 ± 4.1 (range, 24 to 50 years). During the arthroscopic surgery, all patients had labral tears with posterior acetabular rim fracture. All patients had loose osteochondral fragments. Five had partial or complete tears of ligamentum teres. Two patients had osteochondral damage. Two had capsular rupture. Postoperative X‐ray films and three dimension computed tomography (3D‐CT) showed satisfactory reduction of posterior acetabular wall fractures. The mHHS before surgery and at 1 year and 2 years after surgery were 51.8 ± 4.3, 81.8 ± 2.0 and 87.5 ± 1.9 respectively; VAS scores were 5.6 ± 0.5, 1.3 ± 0.3 and 0.7 ± 0.3 respectively. As compared with the condition before surgery, there was a significant improvement in the mHHS and VAS scores at 1 year and 2 years after surgery (P < 0.01). There was no significant improvement in the mHHS and VAS scores between 1 year and 2 years after surgery (P < 0.05). At the final follow‐up, all patients had regained full range of motion (ROM) and were satisfied with the results. None of the patients showed signs of heterotopic ossification, avascular necrosis or progression of osteoarthritis of the hip joint.ConclusionTraumatic dislocation is accompanied by a variety of intra‐articular hip joint pathologies. Managing posterior acetabular rim fracture after traumatic posterior hip dislocation using arthroscopic reduction and fixation with anchors is a safe and minimally invasive option and delays the progression of traumatic osteoarthritis.

Os acetabuli-a new arthroscopic treatment option for the acetabular rim fracture.

Os acetabuli (Os) or acetabular rimfractures are often seen in femoroacetabular impingement patients and can result in groin pain. When seen in symptomatic patients, the question is whether to remove them or to fixate the loose fragment to the acetabular rim. This depends on acetabular coverage and the extent of the Os. If removal of the Os might lead to hip dysplasia and instability, fixation of the Os should be the goal. This technical article describes the author's technique in fixating the Os with a suture-bridge technique.

Arthroscopic Fixation of Os Acetabuli and Labral Repair: Suture-on-Screw Technique

Os acetabuli is thought to be the result of an unfused ossification center or an acetabular rim fracture in the setting of femoral-sided femoroacetabular impingement syndrome. Historically, patients with symptomatic hips have been treated with resection alone; however, in patients with large bone fragments or with reduced acetabular coverage prior to surgical intervention, iatrogenic dysplasia and structural instability may develop after resection. Therefore, for patients with an acetabular os, labral tearing, and cam-type femoroacetabular impingement, internal fixation of the os acetabuli, femoral osteochondroplasty, and labral repair have been described. We propose a “suture-on-screw” arthroscopic technique to simultaneously address both the labral tear and os acetabuli, thereby reducing the number of suture anchors required for labral fixation, leading to an efficient and cost-effective approach for the treatment of these patients.

Treatment of Labral Calcification in the Setting of Femoroacetabular Impingement Syndrome With Arthroscopic Calcification Excision, Labral Repair, and Osteoplasty Improves Outcomes

To describe the diagnosis and 2-year outcomes of arthroscopic treatment for labral calcification in the setting of femoroacetabular impingement syndrome (FAIS). A retrospective analysis was performed from a prospectively collected database of patients with FAIS undergoing hip arthroscopy. Patients with FAIS with labral calcification were differentiated radiographically from patients with other paralabral radiopaque densities such as os acetabuli, acetabular rim fractures, and labral ossification. Patients with FAIS with labral calcification were treated with arthroscopic calcification excision, labral repair, and osteoplasty and matched by age, sex, and body mass index with a cohort of patients with FAIS without labral calcifications who underwent labral repair and osteoplasty. Pre- and 2 years postoperatively, patients completed patient-reported outcome (PRO) scores including the modified Harris Hip Score, Hip disability and Osteoarthritis Outcome Score (HOOS), 12-item Short-Form survey, and visual analog scale. In total, 40 hips (21 male, 19 female) with FAIS and labral calcification were included (age 36.8 ± 8.1, body mass index, 25.9 ± 4.5). Patients with FAIS with labral calcification demonstrated similar significant PRO score improvements compared with a matched cohort of patients with FAIS without labral calcification at 2 years after surgery (visual analog scale: (-)2.3 ± 0.4, (-)2.7 ± 0.5, modified Harris Hip Score: 16.1 ± 2.6, 17.1 ± 3.2; HOOS symptoms: 21.9 ± 3.7, 18.6 ± 3.6; HOOS pain: 22.1 ± 3.0, 25.0 ± 3.5; HOOS activities of daily living: 20.2 ± 2.8, 23.8 ± 3.3; HOOS sport: 35.6 ± 5.0, 35.6 ± 4.1; HOOS quality of life: 36.9 ± 4.5, 37.5 ± 4.4; 12-item Short-Form survey physical component summary: 15.5 ± 2.3, 20.1 ± 2.1, respectively). Both cohorts achieved minimal clinically important differences at equivalent rates (60%-82.5%) for all PRO scores. Patients with labral calcification in the setting of FAIS can be effectively treated with arthroscopic calcification excision, labral repair, and osteoplasty. These patients demonstrate significant improvements in patient-reported outcomes and achievement of minimal clinically important differences at 2 years similar to patients undergoing arthroscopic treatment for FAIS without labral calcification. Level III, matched cohort study.

Réduction sous contrôle arthroscopique des luxations postérieures de hanche causées par une rupture du mur périphérique du labrum: résultats cliniques et radiologiques à moyen terme

BackgroundNon-concentric reduction of hip posterior dislocation caused by the acetabular labrum rim fracture is rare. There has been very little study on the feasibility of arthroscopically treatment and medium and mid-term evaluation to this pathology. The objectives of the current study were: (1) Is the arthroscopically-assisted technique feasible to this manage this injury? (2) What is the effectiveness of arthroscopic treatment for nonconcentric reduction of hip posterior dislocation caused by acetabular labrum rim fracture. HypothesisArthroscopically-assisted procedure is an alternative treatment modality for non-concentric reduction of hip posterior dislocation caused by acetabular labrum rim fracture. Patients and methodsThirteen of 257 posterior hip dislocations who were admitted to our hospital from February 2008 to March 2017 were included: 9 males and 4 females, with an average age of 23.7 (15–36) years. All of them underwent hip posterior dislocation and nonconcentric reduction related to acetabular labrum rim fracture. All of them had arthroscopic reduction and fixation of the rim fracture. Visual Analogic Score (VAS) score, modified Harris score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and the last follow-up radiographs were analyzed respectively. Postoperative complication and the need for secondary operation were recorded during the process. ResultsThe incidence rate of this pathology was nearly 5 %. Twelve out of 13 patients were followed-up for an average of 42 (range, 26–68) months. At the final follow-up, VAS score was decreased from 5.2±0.9 (range, 4.0–6.1) preoperatively to 0.5±0.5 (range, 0.0–1.0) (p<0.0001), modified Harris score and WOMAC score were increased statistically significant from 32±8 (range, 28–40) and 30±5 (range, 25–35) to 94±5 (range, 89–99) and 95±4 (range, 91–99) respectively (p<0.0001). All patients have had completely concentric reduction and returned to activities of daily life. There was not any hip arthroscopic complication such as sciatic nerve injury and intra-abdominal fluid extravasation. Besides, there were no aseptic necrosis and revision case. ConclusionArthroscopically-assisted procedure is an alternative treatment modality for non-concentric reduction of hip posterior dislocation caused by the acetabular labrum rim fracture without surgical dislocation procedure. Good clinical results can be achieved without any complications related to the surgical procedure. Level of evidence: level IV, therapeutic case series.

Arthroscopically assisted treatment for nonconcentric reduction of hip posterior dislocation caused by acetabular labrum rim fracture: Medium-term clinical and radiological outcomes

BackgroundNonconcentric reduction of hip posterior dislocation caused by the acetabular labrum rim fracture is rare. There has been very little study on the feasibility of arthroscopically treatment and medium and mid-term evaluation to this pathology. The objectives of the current study were: (1) Is the arthroscopically assisted technique feasible to this manage this injury? (2) What is the effectiveness of arthroscopic treatment for nonconcentric reduction of hip posterior dislocation caused by acetabular labrum rim fracture. HypothesisArthroscopically assisted procedure is an alternative treatment modality for nonconcentric reduction of hip posterior dislocation caused by acetabular labrum rim fracture. Patients and methodsThirteen of 257 posterior hip dislocations who were admitted to our hospital from February 2008 to March 2017 were included: 9 males and 4 females, with an average age of 23.7 (15–36) years. All of them underwent hip posterior dislocation and nonconcentric reduction related to acetabular labrum rim fracture. All of them had arthroscopic reduction and fixation of the rim fracture. Visual Analogic Score (VAS) score, modified Harris score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and the last follow-up radiographs were analyzed respectively. Postoperative complication and the need for secondary operation were recorded during the process. ResultsThe incidence rate of this pathology was nearly 5%. Twelve out of 13 patients were followed up for an average of 42 (range, 26–68) months. At the final follow-up, VAS score was decreased from 5.2±0.9 (range, 4.0–6.1) preoperatively to 0.5±0.5 (range, 0.0–1.0) (p<0.0001), modified Harris score and WOMAC score were increased statistically significant from 32±8 (range, 28–40) and 30±5 (range, 25–35) to 94±5 (range, 89–99) and 95±4 (range, 91–99) respectively (p<0.0001). All patients have had completely concentric reduction and returned to activities of daily life. There was not any hip arthroscopic complication such as sciatic nerve injury and intra-abdominal fluid extravasation. Besides, there were no aseptic necrosis and revision case. ConclusionArthroscopically assisted procedure is an alternative treatment modality for nonconcentric reduction of hip posterior dislocation caused by the acetabular labrum rim fracture without surgical dislocation procedure. Good clinical results can be achieved without any complications related to the surgical procedure. Level of evidenceLevel IV, therapeutic case series.

Classifications in Brief: The Pipkin Classification of Femoral Head Fractures.

Classifications in Brief: The Pipkin Classification of Femoral Head Fractures.

Clinical outcomes of patients with symptomatic acetabular rim fractures after arthroscopic FAI treatment.

ABSTRACTThis study aims to investigate the influence of the acetabular rim fractures on outcomes of hip arthroscopy at minimum 2-year follow-up. Between January 2009 and August 2012, data were prospectively collected on all patients undergoing hip arthroscopy. Anatomic findings, including presence of rim fractures, were recorded intraoperatively. Patients were assessed preoperatively and at 3 months, 1 year and minimum 2 years postoperatively with four patient-reported outcome measures: modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Activities of Daily Living and Hip Outcome Score-Sport Specific Subscales. Pain was estimated using a visual analog scale. Satisfaction was measured on a scale from 0 to 10. Patients with rim fractures were identified and retrospectively matched to a control group based on gender, BMI category, and age at surgery within 3 years and compared in terms of demographic factors, intraoperative findings, procedures and outcomes. Twenty-one patients with rim fractures were matched to a control group of 21 patients with symptomatic femoroacetabular impingement without rim fractures. No significant differences were detected with respect to demographic characteristics, surgical procedures (besides the removal of rim fractures), or in terms of preoperative, postoperative, or improvement in patient-reported outcome scores and satisfaction. The presence or absence of an acetabular rim fracture does not significantly influence clinical outcomes at minimum 2-year follow-up after hip arthroscopy. Case–control study design is used in this study.

Digastric Trochantric Flip Osteotomy When and How to do it in Acetabular Fractures ?

There comes a time in acetabular fractures-posterior wall and or posterior column fractures when simple Kocher-Langenbeck Approach seems handicapped and you need to have some extension, as in cases of cranial extension of posterior wall fractures and /or need to retrieve loose segments from acetabular joint when with all efforts made by traction, space seems wanting. Kocher-Langenbeck Approach used for posterior and posterior column injuries and also for some T type fractures, gives very little access to intra articular injuries despite a good traction. Gluteus medius tenotomy and Trochantric osteotomy was done earlier [still being done by some ] but of late Digastric Flip Osteotomy is gaining popularity as it is less traumatic and helps saving blood supply and ,thus reduce chances of AVN. The femur head is dislocated anteriorly or posteriorly, without much difficulty and internal status of the joint is observed without having to worry about devascularization of acetabular wall leading to further complications. So to enumerate the need for Digastric Flip Osteotomy in acetabular fractures are- 1.-intra-articular fragments, 2. Impaction of fragments 3. Posterior wall comminution free fragments, 4. Superior acetabular rim or dome fractures, 5. Assessment of the reduction of the anterior Column, and finally 6. Intra-articular assessment of placement of a long screw inserted into the anterior column. Keywords: Digastric flip osteotomy posterior wall, posterior column, intra articular fragments, head dislocation.

Arthroscopic Fixation of Os Acetabuli Technique: When to Resect and When to Fix

Acetabular rim fractures, or os acetabuli, are hypothesized to occur as a result of an unfused ossification center or a stress fracture from repetitive impingement of an abnormally shaped femoral neck against the acetabular rim. When treated surgically, these fragments are typically excised as part of the correction for femoroacetabular impingement. However, in some patients, removal of these fragments can create symptoms of gross instability or microinstability of the hip. In these cases, internal fixation of the fragment is necessary. The purpose of this technical note is to describe indications, the arthroscopic technique, and postoperative care for fixation of acetabular rim fractures.

Missed adolescent acetabular apophyseal avulsion with late hip dislocation

BackgroundChronic hip dislocation associated with acetabular apophyseal avulsion in adolescence is rare. Whilst superior acetabular rim fractures have a documented theoretical risk of hip instability, we have not found a case of chronic dislocation resulting from this. MethodsWe report a case of a 12-year-old healthy boy who initially sustained a missed right acetabular apophyseal avulsion after falling from a quad bike. This was missed on the initial radiograph and a subsequent radiograph following weight bearing a few days later showed a hip dislocation that was also missed. Upon diagnosis at 6 weeks, he underwent open reduction but also required acetabuloplasty to stabilise the hip. ResultsAt 2 years follow-up, he was enjoying pain free swimming, cycling and walking. His Harris hip score was 87. ConclusionThis case reinforces the need for recognition that in the patient presenting with knee or thigh pain, exclusion of hip pathology is required. It also explores the pitfalls of diagnosis associated with rare patterns of injury and the need for adequate investigations such as examination under anaesthetic, arthrography and MRI. The use of acetabuloplasty is shown to be a useful strategy for the unstable hip resulting from irreparable acetabular rim fracture.

Surgical Hip Dislocation is Safe and Effective Following Acute Traumatic Hip Instability in the Adolescent.

A traumatic hip dislocation in the pediatric patient is a rare but potentially catastrophic injury. The purpose of this study was to review our early clinical results and radiographic morphology of hips treated with a surgical hip dislocation (SHD) approach for intra-articular hip pathology resulting from traumatic instability in pediatric and adolescent patients. This is a retrospective analysis of a consecutive series of patients presenting with nonconcentric reduction after traumatic hip instability. All patients were treated with a transtrochanteric SHD with concomitant procedures based on intra-articular findings. Radiographic evaluations and Harris Hip Scores were completed at final follow-up. Eleven male patients, mean age of 12.3 years (range, 9.3 to 16.1 y) and mean body mass index 19.6 kg/m (range, 15.4 to 28.0 kg/m). Intraoperative findings included: labral tear (8), femoral cartilage injury (5), acetabular rim fracture (4), acetabular cartilage delamination (3), loose body (2), and femoral head osteochondral fracture (1). Postoperatively, 1 patient developed a transient peroneal nerve palsy. At a mean 24.5 months (range, 12.0 to 48.1 mo) postoperatively, no hips have radiographic evidence of osteonecrosis. The mean lateral center edge angle was 20 degrees (range, 9 to 38 degrees) with 6 hips of <20 degrees; mean acetabular index 9 degrees (range, -2 to 23 degrees) with 5 hips of >10 degrees; mean α-angle 56 degrees (range, 48 to 62 degrees) with 6 hips of >55 degrees; mean acetabular version 12 degrees (range, 8 to 16 degrees) with 8 hips of <15 degrees. At 1-year follow-up, the mean Harris Hip Score was 95.8 (range, 84.7 to 100). Early results suggest that SHD is a safe approach to treat an incomplete reduction following posterior hip instability and is effective for identification and treatment of acute intra-articular pathology. Acetabular dysplasia, relative acetabular retroversion, and/or decreased femoral offset may be risk factors for posterior hip instability in adolescents. Level IV.