Hip Injuries Research Articles

Are all cases of floating hip the same? Further understanding of floating hip

PurposeFloating hip is a severe high-energy injury. Femoral fracture is an essential component of floating hip. However, few studies have addressed the relationship between the femoral fracture pattern and floating hip injury. In this study, we reviewed and summarized the epidemiological and clinical data of patients with floating hip.Patients and methodsWe retrospectively reviewed patients with a diagnosis of floating hip at our trauma center from January 2014 to December 2021. Data on patient demographics, characteristics of the injuries, associated injuries, whether sciatic nerve palsy (SNP) occurred, the number of operations performed, and the total length of hospital stay were analyzed.ResultsA total of 76 patients met the diagnostic criteria for floating hip, 45 of whom had proximal femoral fractures. The mean Injury Severity Scores in patients with proximal and non-proximal femoral fractures were 21.47 ± 10.67 and 17.61 ± 7.64, respectively, and the mean Abbreviated Injury Scale scores were 13.31 ± 9.71 and 9.52 ± 4.32, respectively. Motor vehicle collision and a fall from a height were the main causes of injury. Chest injury was the most common associated injury. Twenty-two patients were diagnosed with SNP, 17 of whom had a proximal femoral fracture. Of the patients with pelvic fractures, 15 were diagnosed with SNP, 14 of whom also had a proximal femoral fracture. Of the patients with acetabular fractures, seven were diagnosed with SNP, three of whom also had a proximal femoral fracture.ConclusionMore than half of patients with floating hips have a combined proximal femoral fracture. In this study, fracture of the pelvis or acetabulum combined with a proximal femoral fracture had a higher AIS score and higher risk of SNP than fracture of the pelvis or acetabulum combined with a non-proximal femoral fracture. Patients with a single pelvic fracture showed similar results, but patients with a single acetabular fracture did not. A pelvic or acetabular fracture combined with a proximal femoral fracture has a different outcome than a mid-distal femoral fracture, which may be a “true” floating hip.

Advancing Recovery by Incorporating Physiological Insights into the Surgical Management of Chronic Proximal Rectus Femoris Tendon Avulsion

Background: Tendon lesions affecting the proximal rectus femoris (PRF) muscle represent about 1.5% of hip injuries. Most acute cases are managed conservatively with physiotherapy. There is a lack of consensus regarding surgical intervention for chronic injuries. This article, alongside a literature review, presents a case of anatomical surgical reinsertion for chronic complete avulsion rupture of the PRF tendon. Case Report: A 34-year-old amateur athlete experienced acute inguinal pain from overexertion, with conservative treatment having failed over 3 months. Seven months later, proximal tendon rupture involving both PRF muscle heads was confirmed. An anterior Hueter approach released the tendon from the adhesions and fibrosis. The direct portion was reinserted into the inferior anterior iliac spine, and the reflex portion was reattached to the supraacetabular groove. The patient showed excellent improvement on the modified Harris Hip and Lysholm–Tegner scales. The quadriceps muscle force decreased by 20% compared to the contralateral leg at 3 months, reducing to 4% by 12 months. Normal activities resumed after six weeks, and sports resumed after 4 months. Conclusions: The patient experienced significant postoperative improvement, as shown by the enhanced functional scores and muscle force recovery over one year. The success of the anatomical reconstruction in restoring tendon continuity underscores the importance of tendon healing mechanisms, including tissue remodeling and revascularization, in chronic avulsion injuries. This case highlights the efficacy of anatomical reconstruction for chronic PRF tendon avulsion. The literature review offers further insights into treatment options and the physiological basis of recovery for such injuries.

Research on the impact of congenital joint activity and flexibility on the development of dancers

Abstract. The importance of range of motion and flexibility in dance training is self-evident. The article aims to solve the typical training problem of dancers due to the growth difference between joints and muscles under various conditions. Common hip injuries in dance training include iliopsoas muscle strain, synovitis, etc., which may be caused by sudden twisting or overextension of the hip joint. To improve flexibility, auxiliary training such as Pilates has become the first choice for dancers, by strengthening the toughness and stretching of fascia and muscles, reducing the risk of hip friction and injury. In auxiliary training, the training of antagonist muscles is crucial, by transposing a set of antagonist muscles to exert force, effectively improving leg flexibility while maintaining joint stability. In addition, the activation of the physical function of the trainees before the class is also key, and the warm-up activities are used to increase the level of bursts and reduce the risk of muscle strain. Taking into account the range of motion, flexibility training, and physical function activation, we can provide dancers with a more scientific and effective dance training program to ensure their physical health and performance quality.

Impact of strength training on the prevention of orthopedic injuries in sports: a literature review.

Introduction: The perception of physical activity has evolved, influenced by urbanization, media, and public health initiatives. While regular physical activity offers health benefits, musculoskeletal injuries in athletes remain a concern, often going unnoticed due to subtle symptoms. Preventing these injuries is crucial, with strength training (ST) emerging as a strategy to enhance stability and reduce injury risk. Purpose of the Study: This review examines the impact of strength training on preventing orthopedic injuries in athletes, focusing on mechanisms like muscle strengthening, joint stabilization, improved endurance, and correcting imbalances. It evaluates research on ST's effectiveness in preventing knee, ankle, hip, back, and upper limb injuries. Methodology: A comprehensive search of databases, including PubMed, Scopus, and Google Scholar, was conducted using keywords such as "strength training," "orthopedic injury prevention," "musculoskeletal stability," "injury risk reduction," and "sports injuries." Results: Strength training plays a key role in preventing sports injuries by enhancing muscle strength, joint stability, and endurance, addressing musculoskeletal weaknesses and imbalances. Studies show ST significantly reduces knee, ankle, hip, and back injuries. For instance, knee injuries are prevented by strengthening the hip abductors and quadriceps, while ankle injuries are mitigated by improving core and lower limb strength. ST also prevents injuries in "overhead sports" by enhancing shoulder stability. Keywords: strength training, orthopedic injury prevention, musculoskeletal stability, sports injuries, injury risk reduction.

Compressive force and valgus torque are the predominant applied loads during the pivot shift exam: An in vitro study.

Despite the clinical utility of the pivot shift exam, the requisite applied forces and torques to elicit a pivot shift remain unclear. The purposes of this study are (1) to identify the greatest forces and torques applied to the knee during the pivot shift exam and (2) to evaluate if the applied loads differ among experienced surgeons. Three cadaveric hemipelvis-to-toe specimens (ages 53, 36 and 31 years; two males and one female) with no history of knee or hip injury were utilized. The experimental setup consisted of securing the hemipelvis to a mounting frame via an external fixator to simulate patient positioning during the clinical exam. The hemipelvis, femur, and tibia were spatially tracked by motion capture and the applied loads were measured using a 6-axis force-torque sensor. After sectioning the anterior cruciate ligament (ACL), three board-certified sports medicine surgeons then performed the pivot shift exam on each specimen utilizing their preferred technique. Forces (compression-distraction, anterior-posterior, and medial-lateral) and torques (varus-valgus, internal-external rotation, and flexion-extension) applied to the knee joint immediately preceding the reduction of the proximal lateral tibia during each pivot shift exam were calculated. Compression was the largest applied force averaging 95 N ± 15 N for all surgeons and knees, which was at least 4.5 times greater, on average, than the applied anterior and applied medial tibial forces (p < 0.0001). Valgus was the largest of the three applied torques, averaging 8.5 ± 2.1 Nm. Internal rotation torque was 3.7 times less, on average, than the applied valgus torque (p < 0.0001). Each surgeon applied compressive force. However, anterior force was more variable among surgeons, with one of the three surgeons applying minimal anterior force (p ≤ 0.024). The magnitude of applied torques was similar among examiners (n.s). Compressive force and valgus torque were the predominant applied loads during the pivot shift exam. A lower magnitude of internal rotation torque was also applied. The anterior force was not consistently applied among examiners. These data can better inform clinical, cadaveric, and computational studies utilizing the pivot shift exam to assess knee biomechanics and can be used to educate trainees in conducting this complex manoeuvre. An in vitro biomechanic study.

AKT question relating to hip injuries

AKT question relating to hip injuries

AKT answer relating to hip injuries

AKT answer relating to hip injuries

Advancements of biomaterial in hip replacement technology incorporating ceramic materials

The increasing prevalence of hip joint diseases is closely linked to improved living standards and an aging population, leading to a rise in conditions like degenerative arthritis and severe hip injuries. These conditions cause significant pain and functional impairments, greatly reducing the quality of life for affected individuals. Total hip arthroplasty (THA) has become a well-established surgical intervention to address these debilitating conditions. Within the realm of hip replacement materials, ceramics have garnered attention for their exceptional wear resistance and ability to minimize complications, such as bone dissolution caused by wear particles. Ceramics, such as alumina and zirconia, offer biocompatibility and low wear rates, making them favourable choices for hip prostheses. However, despite these advantages, the use of ceramics in hip replacements is not without challenges. Issues such as ceramic fragmentation and abnormal joint noise have been noted, posing significant obstacles to their widespread adoption. This review explores the advancements in hip replacement technology with a particular focus on ceramic materials. It delves into the properties that make ceramics suitable for this application, such as their biocompatibility and mechanical strength, enhanced through advanced manufacturing techniques. Additionally, the review addresses the ongoing challenges, including strategies to mitigate the risk of fragmentation through material toughening and improved prosthesis design. Furthermore, it examines the phenomenon of abnormal joint noise, proposing solutions that involve refinements in implant design, surgical techniques, and post-operative patient management. The aim of this review is to provide a comprehensive overview of current advancements and future directions in the use of ceramic materials in hip replacement technology, highlighting the potential for improved patient outcomes and the need for continued research and innovation in this field.

Hip and groin pain in sport

Hip and groin pain is a common symptom in the athletic population. Kicking sports are the most affected, with groin injuries accounting for almost one fifth of all injuries in male club football. Despite the frequency at which these injuries occur, diagnosing the cause of hip and groin pain can be a challenge. Correct diagnosis and management of hip and groin injuries in primary care can improve outcomes in patients by reducing the likelihood of re-injury and avoiding the development of chronic issues. This article aims to discuss the common causes of hip and groin pain in sports, and how to assess, investigate and manage these injuries.

Patient-reported outcomes in total hip arthroplasty for patients with anatomically contoured femoral heads.

Iliopsoas tendinitis after total hip arthroplasty (THA) has become more prevalent with the increased use of large-diameter femoral heads impinging on native surrounding tissues. Anatomically contoured heads (ACH) are soft-tissue-friendly femoral heads created to minimise this issue. This retrospective study assesses iliopsoas tendinitis prevalence and re-operations in primary THAs with ACH, while determining the minimal clinically important difference (MCID) achievement and improvement with 5 patient-reported outcome measures (PROMs). We conducted a retrospective analysis of 53 ACHs from January 2020 to July 2023. Patients who completed Hip Injury and Osteoarthritis Outcome Score-Physical Function Short Form (HOOS-PS), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PF SF-10a), PROMIS Global Health (GH)-Mental, or PROMIS GH-Physical, and pain score questionnaires were identified. PROM scores were collected preoperatively and at 3-month and 1-year postoperative intervals. Comparisons using chi-square and ANOVA tests were applied. The rates of achieving MCID and improvement within the first year were (69.2 vs. 76.9%) for PROMIS GH-Physical, (38.5 vs. 46.2%) for PROMIS GH-Mental, (71.4 vs. 92.9%) for HOOS-PS, (80.0 vs. 80.0%) for PROMIS PF SF-10a, and (74.0 vs. 91.7%) for pain scores. PROM scores at 3 months and 1 year significantly varied across all categories, except for PROMIS GH-Mental. No patients had iliopsoas tendinitis, dislocations, or re-operations. ACH implants may alleviate anterior hip pain, while maintaining comparable strength and bio-compatibility to conventional femoral heads. This study underscores the early safety and potential of ACH implants in reducing iliopsoas tendinitis and impingement.

Mobile assessment of visual function helps to prevent Re-Injury in elderly patients with recent hip fractures

IntroductionPatients undergoing surgery due to hip fracture face an elevated risk of a subsequent fall during rehabilitation. An important contributing factor to this risk is deteriorated visual function, often responsive to intervention. This study aims to explore differences in visual acuity (VA) and stereovision (SV) between individuals with a history of fall-related hip injuries (study group) and age-matched controls, utilizing a mobile application (EuvisionTab, ET) to distinguish age-related visual decline from pathological vision. Materials & MethodsA total of 32 and 71 participants were enrolled in the study and control groups, respectively (mean age: 74.9 years, range: 60–96). Monocular logMAR VA was measured using a tablet by means of an adaptive threshold-search algorithm. SV was assessed using low-dot density static and dynamic random dot stereograms. An age-dependent reference limit for VA was established. For ET stereotests, the number of correctly identified optotypes out of 10 random presentations served as the measure for further comparisons. Visually impaired status in the study group was determined if patients failed either the VA threshold or the SV criteria. ResultsIn the control group, an apparent but statistically nonsignificant decline in VA was observed, while stereovision remained stable and did not exhibit significant age-related variations based on ET stereotests. Conversely, the study group demonstrated significantly worse results in monocular VA (p = 0.0032) and for both stereotests (p = 0.018 for static, p = 0.036 for dynamic) according to paired samples t-test and chi-square test, respectively. Hip injuries were significantly associated with visual impairment (OR = 4.88, p = 0.0012). DiscussionThis study focuses on one possible risk factor of elderly falls, namely, vision impairment. Patients with visual decay present a higher incidence of hip injuries compared to age-matched controls. This data suggest that vision screening and, when feasible, restoration of visual function may contribute to the prevention of secondary falls, refractures, or contralateral fractures. A mobile-based screening protocol, executable as part of a postoperative bedside examination and independent of specialized eye care, can be proposed.

Hip Injuries in the Pediatric Athlete—Pelvic Apophyseal Avulsions

Pelvic apophyseal avulsion fractures have been occurring more commonly in young athletes in the context of increased intensive year-round training and early specialization in youth sports, and this diagnosis must be considered in the pediatric patient presenting with hip pain. An understanding of the relevant anatomy can guide the history and physical exam to arrive at the diagnosis, which is usually confirmed with plain radiographs. Although non-operative management remains the mainstay of treatment for these patients, surgery may be warranted for ischial tuberosity fractures displaced > 2 cm and for symptomatic nonunions The objective of this review is to provide a comprehensive overview of pelvic apophyseal avulsion injuries.

2308 A pilot project implementing a dysphagia screening tool for femoral fracture patients.

Abstract Background Evidence suggests 30–40% of patients with a neck of femur fracture (NOF#) develop oropharyngeal dysphagia (OPD) during the perioperative period. 1–2 Our data, collected over two months, shows our Speech and Language Therapy Team (SLT) identified only 12% of cases. Given the importance of nutrition and medication in the perioperative period, early identification of OPD is critical. We launched a new dysphagia screening tool for all patients admitted to our hospital with a NOF#. Methods A retrospective review of patient notes allowed collection of data regarding age, hip injury, frailty score, comorbidities, and staff compliance with tool. Patients with a completed screening tool had outcomes recorded (low, medium, high risk), timeliness of referral to SLT if appropriate, and if OPD was present on assessment. Balancing measures included length of time kept nil by mouth. We completed four PDSA cycles over 5 months. Results During this period, 157 patients were admitted with a NOF# and 58 had a completed screening tool. By producing a training pack and expanding into the emergency department, compliance improved by 33% over the 4 cycles. 19 of the 58 patients with a completed screening tool had OPD; 79% had mild, 14% moderate and 7% severe. The screen was adjusted during each cycle improving the suitability of SLT referrals from a 25% identification rate in cycle 1 to 100% in cycle 4. No patients were kept nil by mouth. Conclusions The screening tool has increased OPD identification by 21%. However, this requires staff training and high compliance rates to be effective. Next steps include adding the tool to the NOF# proforma, creating a training pack for the wider MDT, and improving the specificity of the tool.

Advancements in ceramic-on-ceramic bearing materials for total hip arthroplasty: Properties, challenges, and future directions

Total hip arthroplasty (THA) is a vital procedure for addressing hip injuries and end-stage arthritis, offering relief to millions annually. However, long-term issues like femoral headwear and osteolysis persist, with 25-year survival rates of around 77.6%. Material selection significantly influences THA outcomes. This article investigated five typical ceramic-on-ceramic (CoC) bearing materials, including alumina, zirconia, zirconia-toughened alumina (ZTA), delta ceramic, and sapphire. Alumina, known for hardness and wear resistance, improved with lower fracture rates, and some squeaking and zirconia ceramics addressed fractures but require impurity reduction. ZTA combines alumina and zirconia, excelling in mechanical properties but also exhibiting squeaking. Optimized with nanostructures, delta ceramic shows fracture resistance despite occasional squeaking. Sapphire offers excellent biocompatibility but requires complex manufacturing and more clinical trials. The quest for optimal THA-bearing surfaces is ongoing, demanding rigorous research and collaboration.

The ballistic articular structure injury classification (BASIC) system: clarifying ballistic articular injuries.

This study aims to (1) devise a classification system to categorize and manage ballistic fractures of the knee, hip, and shoulder; (2) assess the reliability of this classification compared to current classification schemas; and (3) determine the association of this classification with surgical management. We performed a retrospective review of a prospectively collected trauma database at an urban level 1 trauma centre. The study included 147 patients with 169 articular fractures caused by ballistic trauma to the knee, hip, and shoulder. Injuries were selected based on radiographic criteria from plain radiographs and CT scans. The AO/OTA classification system's reliability was compared to that of the novel ballistic articular injury classification system (BASIC), developed using a nominal group approach. The BASIC system's ability to guide surgical decision-making, aiming to achieve stable fixation and minimize post-traumatic arthritis, was also evaluated. The BASIC system was created after analysing 73 knee, 62 hip, and 34 shoulder fractures. CT scans were used in 88% of cases, with 44% of patients receiving surgery. The BASIC classification comprises five subgroups, with a plus sign indicating the need for soft tissue intervention. Interrater reliability showed fair agreement for AO/OTA (k = 0.373) and moderate agreement for BASIC (k = 0.444). The BASIC system correlated strongly with surgical decisions, with an 83% concurrence in treatment choices based on chart reviews. Conventional classification systems provide limited guidance for ballistic articular injuries. The BASIC system offers a pragmatic and reproducible alternative, with potential to inform treatment decisions for knee, hip, and shoulder ballistic injuries. Further research is needed to validate this system and its correlation with patient outcomes. Level III, Diagnostic Study.

Awake fiberoptic intubation of a patient with severe multiple trauma in prone position: a case report

BackgroundFiberoptic-guided intubation is considered as “gold standard” of difficult airway management. Management of the airway in prone position in patients with severe trauma presenting with penetrating waist and hip injury poses a major challenge to the anesthesiologist.Case presentationA man presented with severe multiple trauma and hemorrhagic shock as a result of an industrial accident with several deformed steel bars penetrating the left lower waist and hip. It was decided to schedule an exploratory laparotomy following extracting the deformed steel bars. Successful administration of awake fiberoptic nasotracheal intubation, performed in a prone position under airway blocks and appropriate sedation, allowed for the procedure. The exploratory laparotomy revealed damage to multiple organs, which were repaired sequentially during a 7-hour surgical operation. The patient’s recovery was uneventful, and he was discharged from the hospital one month after the surgery.ConclusionsAwake fiberoptic nasotracheal intubation, along with airway blocks and appropriate sedation, can be a viable option in patients with severe multiple trauma in the prone position.

Hip Sideline Emergencies and Hip Injuries in Elite Athletes.

Hip injuries in elite athletes are an increasingly recognized problem and range from chronic overuse injuries, such as adductor strains and labral tears, to acute traumatic injuries such as hip dislocations. In this article, we review common hip pathology experienced by elite athletes and sideline management of emergent hip injuries. Elite athletes are subject to unique physical and mental stresses and therefore must be evaluated and treated in a unique manner. Hip and groin injuries account for approximately 6% of sport injuries overall and 3-15% of all injuries in professional sports. Hip sideline emergencies were rare but can include hip dislocations, subluxations, and avulsion fractures. Hip and groin injuries represent an important subset of injuries which can greatly impact an athlete's ability to perform. Understanding the physiology and types of hip/groin injuries, which athletes are prone to injuries, the impact on recovery time, recurrence risk, and the potential need for surgery aid sports medicine physicians in decision-making.

Hip Injury

Hip Injury

Unnecessary Roughness: The NFL's War on Drugs in the 1970s

In April 1970, the African American defensive end Houston Ridge's $1.25 million lawsuit put the issue of drug use in professional football in the public eye. It also raised questions about the league's exploitation of athletes for the sake of profits, at any cost. Plagued by a hip injury sustained during a game in October 1969, the twenty-five-year-old former San Diego Charger's suit charged conspiracy and malpractice, naming team personnel and both the American Football League (AFL) and the National Football League (NFL) as defendants. Ridge's suit claimed that he was permanently disabled, in part, because of the mix of amphetamines, barbiturates, and methandrostenlone given to him by the Chargers, “not for the purpose of care,” but for the purpose of performance enhancement. And they had done so “without warning him of the consequences.” An X-ray later revealed that he had broken his hip, but the drugs had so dulled his sensation of pain that he had continued to play, exacerbating the injury. A married father of four who now had to walk with the help of crutches, Ridge also filed a worker's compensation claim, accusing the Chargers with willful misconduct.

Orthopedic Hip Injuries Encountered in the Primary Care Setting

Orthopedic Hip Injuries Encountered in the Primary Care Setting