Restore Joint Congruity Research Articles

Posteromedial Buttress Plate for Schatzker 6 Fractures as Double Column Fixation

Objective: Treatment of Schatzker Type 6 fractures is to use a posteromedial buttress plate as part of a double-column fixation technique. Materials & Methods: The design of this study was a cross sectional study design and this study was conducted in DHQ Teaching Hospital Gujranwala. patients with posterior medial fracture of Schatzker type 6 and having associated damage of some soft tissue present within the joint underwent surgery at our institutional operation theatre. In this Study setting we included total 20 patients (14 male [70%] and 6 females [30%]) who came with Bicondylar fractures having Comminuted Posteromedial Fragments of tibia. Results: Of the Patients, 12 (60%) had excellent results, 5(25%) had good results , and 3 (15%) had fair results. In total, 17 patients (85%) achieved cheering results. Walking, Stability, and motion were good or excellent in all cases. Practical Implication: One of the main advantages of the posteromedial buttress plate fixation technique is that it provides support to the medial column of the tibia, which is an important weight-bearing structure in the lower extremity. By restoring the structural integrity of the medial column, the technique can help promote early weight-bearing and facilitate early rehabilitation. All displaced posteromedial tibial plateau fractures should be surgically stabilized and buttressed using plate to restore joint congruity and prevent late subluxation and early arthritis. The aim is to study the role of posteromedial plating in the management of complex tibial plateau fractures with a posteromedial fragment Conclusion: Use of a posteromedial buttress plate as part of a double-column fixation technique can be an effective approach for treating Schatzker Type 6 fractures. Keywords: Fixation of Posterior Column, Buttress plate, Schatzker 6 fracture

Percutaneous Reduction of Intra-Articular Posterior Wall Acetabular Rim Fragment: Surgical Technique and Case Series With an Average Follow-Up of 2 Years.

Small posterior wall rim fractures are typically stable; however, if incarcerated in the joint, they must be removed. It is possible to reduce the morbidity associated with open approaches by addressing these incarcerated fragments in a percutaneous manner. This allows the restoration of joint congruity and removal of the osteochondral fragment from the joint space. The following report details the surgical technique to accomplish this, and the results of a case series of patients who underwent this technique. The advantages include limiting the morbidity of an open approach. However, the surgeon must be prepared to convert to an open approach if percutaneous removal does not accomplish the goals of surgery-a concentric, stable hip joint.

Management of quadrilateral plate fractures: An up to date

Acetabular fractures are result of mostly high velocity injury with an incidence of 3/100,000/year. However in elderly patent low energy trauma also result in acetabulum fracture due to osteoporosis. Most of acetabular fracture commonly combined with quadrilateral plate fractures. Till date there is no standard classification system for quadrilateral plate fracture of acetabulum is published which can be utilized for accurately studying the fracture pattern and planning for the surgical approach with management. Initially acetabulum fracture was managed conservatively with traction for at least 6 weeks which results in aggravation of secondary symptoms such as pressure sore, DVT, post traumatic arthritis, loss of muscle strength and endurance. Aim of acetabulum fracture fixation are to allow early mobilization, restoring joint congruity, pain relive and reducing the risk of post traumatic arthritis. An internet search of MEDLINE and PMC using the search term 'acetabular fracture', 'quadrilateral plate fracture' and central hip dislocation in English language was performed on 1st march 2021. Papers specific with quadrilateral plate fracture were only included in the study and we found variety of technique available for displaced quadrilateral plate fractures, such as cerclage wire-plate composite, pelvic brim long screws, various combinations of spring plates (T-shaped plate, L-shaped plate, infrapectineal plate, H-plate, and multidirectional titanium fixator. In this review article we studied different treatment modalities and techniques used over several decades for management of quadrilateral fracture with their outcome.

ACROMIOCLAVICULAR AND CORACOCLAVICULAR RECONSTRUCTIONBY NYLON TAPE VERSUS CORACOCLAVICULAR SCREW IN MANAGEMENT OF ACUTE ACROMIOCLAVICULAR DISLOCATION

Background & Purpose: A number of different surgical techniques were described to treat acute acromioclavicular (AC) joint dislocations which aim to restore joint congruity and mechanical stability. The purpose of this study was to compare functional, radiological outcomes and fixation related complications of acromioclavicular and coracoclavicular (CC) reconstruction by nylon tape versus coracoclavicular screw in management of acute acromioclavicular dislocation.Patients &Methods: In the periodfrom September 2017 to December 2019, a prospectiverandomized controlled clinical trial was conducted in Ain Shams University hospitals including 30 cases with types III and V AC injuries. They were divided into two groups, 15 patients underwent AC and C Creconstruction by nylon tape (Group A) and the other 15 patients underwent coracoclavicular screw (Group B).The patients were evaluated forpain, range of motion (ROM), radiologic findings (CC distance difference between both sides was measured), American Shoulder and Elbow Surgeons(ASES), and Constant scores. Postoperative complications were recorded and assessment of time of returning to the work was done. The evaluation was done preoperatively and each time of follow up with a minimum period of one year.Results: After a mean follow up period of 15±2.7 months for group A and 14.37±4.74 months for group B, patients of both groups showed highly significant improvement between mean preoperative and postoperative pain, ROM, Constant, ASES scores and CC distance difference. Group A showed better results as regard mean postoperative ROM, Constant score and ASES score than group B, while group B showed better results as regard mean postoperative pain score and CC distance difference. However, there was no statistically significant difference between the 2 groups. In group A the mean post-operative pain and ROM scores (both as a part of constant score) was 12.67 (±3.2) and 33.53 (±2.9) respectively while in group B was 12.92 (±3.34) and 32.83 (±2.98) respectively. The mean post-operative Constant and ASES scores was 86.93 (±7.22) and 89.93 (±7.5) respectively for group A and 86.17 (±8.33) and 87.58 (±6.08) respectively for group B. Radiographic CC distance difference (mm) between both shoulders at one year postoperatively was 2.27 in group A and 2.13 in group B. There was a statistically significant difference between the mean time to return to work for patients in group A (3.2 months) and patients in group B (4.2 months). Complete loss of reduction occurred in three patients in group B, two cases of subluxation (50 % of the preoperative CC distance difference) in group A, one case of wound infection in each group and one case of fracture clavicle in group B. Conclusion: Both AC and CC reconstruction by nylon tape and CC screw procedures are valid surgical options and have adequate outcome in treatment of patients with acute AC dislocation. However there are some concerns about the failure rate and the need of another operation for screw removal that was present in CC screw group which affects patient satisfaction in that group.

Functional and radiological outcome of schatzker type II, III, VI fractures treated via subchondral RAFT system combined with locking compression plate

Need for the study: Treatment of proximal tibia fracture is difficult especially when intraarticular and metaphyseal comminution present. The tibial plateau involves weight bearing so restoration of joint congruity is important to preserve normal function of knee. Subchondral raft construction is one popular method under investigation for this purpose where subchondral screws support the bone pieces along with cartilage and prevent it to depress again. Aim: to evaluate clinical and radiological results of Schatzker type II, III, VI fractures treated using open reduction and internal fixation with subchondral RAFT system combined with lateral plateau locking compression plates. Methods: 30 patients of proximal tibial plateau split fracture and depression, including men and women aged >18 years who came to department of orthopaedics GMCH between 2017 to 2019 were enrolled in the study. Diagnosis made by x-rays and computerized tomography. In all patients, the depressed joint line was elevated and fixed with subchondral RAFT screws through the locking compression plate. At the last follow up, clinical and radiological data were recorded. Results: The mean ROM was 110.50 (range 900- 1250), Mean KSS was 90.2 (range 65-100), Mean Rasmussen radio score was 15.6(range 10-18). All 30 patients showed signs of fracture healing on follow up x-rays and on final follow up complete bone union. Two patients developed superficial infection and one patient had screw backout on 2nd follow up. none encountered major intra or post-operative complications. Conclusion: Subchondral RAFT combined with locking compression plate helps surgeon to maintain the anatomical reduction of depressed intraarticular fragment with satisfactory functional and radiological outcome.

Morphometric Assessment of the Residual Width of the Distal Hamate Articular Surface after Graft Harvest for Hemi-hamate Arthroplasty.

The hemi-hamate arthroplasty (HHA) can restore joint congruity and stability in chronic fracture-dislocations of the proximal interphalangeal joint (PIPJ). Purpose of this study was to compare the width of the distal hamate articular surface (DHAS) to the width of the base of the middle phalanges (P2) of the fingers. We hypothesized the dimensions of the width of the DHAS would be similar to those of P2, leaving a small amount of residual DHAS width after autograft harvest. Fifty-nine CT scans of the hand without any bony pathology were evaluated. Three observers measured the following parameters and compared: (a) Width of the DHAS in the axial and coronal planes; (b) Width of the P2 articular bases of all four fingers; (c) Maximum capitate length (MaxCap) in the coronal plane. The residual DHAS on the coronal plane after graft harvest (bone remaining on the radial and ulnar aspects each, not accounting for saw blade or osteotomy width thickness) among all patients was 1.3, 0.9, 1.4, and 2.4 mm for the index, long, ring and small fingers respectively. There was a strong correlation between DHAS and MaxCap r=0.76. There is likely to be a very small amount of residual hamate articular surface width left after the graft is harvested if the entire base of P2 is reconstructed.

Return to racing after surgical management of third carpal bone slab fractures in thoroughbred and standardbred racehorses.

To determine the prognosis for racing of horses surgically treated for slab fractures of the third carpal bone (C3). Retrospective case study. Horses (n = 125) surgically treated for C3 slab fractures. Medical records of horses surgically treated for dorsal or sagittal C3 fractures were reviewed for age, sex, breed, limb, fracture type, degree of cartilage damage, and surgical treatment. Radiographs were evaluated to determine fracture depth, width, and displacement. Osteophytes, C3 lysis, and fragmentation were scored. Racing performance was obtained from online databases. Univariable and multivariable analyses were used to determine associations between independent variables and outcomes. Fifty-four (43%) horses raced postoperatively. Among thoroughbreds, 35% (30/86) with dorsal fractures and 63% (17/27) with sagittal fractures raced postoperatively. Among standardbreds, 77% (10/13) with dorsal fractures and 0% (0/2) with sagittal fractures raced postoperatively. Fracture displacement, C3 lysis, and cartilage damage affected the likelihood of racing postoperatively. Placement of 3.5-mm screws vs 4.5-mm screws and the placement of fewer screws were associated with improved likelihood of racing. The prognosis for postoperative racing of thoroughbreds with dorsal C3 fractures was less favorable than that previously reported. Concurrent joint pathology, such as cartilage damage at time of surgery, affected the ability of the horse to race postoperatively. Although internal fixation of C3 slab fractures is required to restore joint congruity, return to racing should be expected in only 42% of thoroughbreds and 67% of standardbreds.

Reconstruction of the middle phalangeal base of the finger using an osteocartilaginous autograft from the hamate

Restoration of proximal interphalangeal joint stability with preservation of mobility by reconstruction of the middle phalanx base using an osteochondral graft from the carpometacarpal joint surface of the hamate. Acute and older isolated destruction of the palmar middle phalanx base >25%. Destruction of the head of the proximal phalanx, advanced chondropathia of the head of the proximal phalanx, extensive soft tissue injury with loss of skin coverage at the proximal interphalangeal joint. The fractured middle phalangeal base is debrided and the defect is replaced by asize-matched autograft from the dorsal carpometacarpal hamate osteoarticular surface that is secured in place with miniscrews. Immobilization for 2weeks in abelow-elbow cast in intrinsic plus position. Subsequent immobilization by asplint including the distal and proximal interphalangeal joint. Healing was achieved in 100% with restoration of joint congruity in 12 of 13cases and slight subluxation in 1case. Follow up was possible in 9cases after 22 ± 16 (5-51) months. The average range of motion in the reconstructed joint achieved 0/9/73°, grip strength 82% of the unaffected side. Of the 9patients, 5 developed amild flexion contracture of the proximal interphalangeal joint. The DASH score achieved 4 ± 3 (0-8)points, pain at rest was 1 ± 2 (0-5), pain at exercise 2 ± 2 (0-5) on avisual analogue scale (0-10). All patients were satisfied and willing to undergo the procedure again. According to the literature, reconstruction of the base of the middle phalanx by using an osteochondral graft from the hamate is areliable procedure to restore stability and mobility of the joint.

Use of Bone Marrow Aspirate Concentrate with Acetabular Labral Repair for the Management of Chondrolabral Junction Breakdown

Despite advances in techniques for acetabular labral repair, strategies for mitigating or reversing damage to the chondrolabral junction do not yet exist. Cartilage repair techniques such as autologous chondrocyte implantation, matrix-induced autologous chondrocyte implantation, osteochondral autograft transfer, microfracture, and bone marrow aspirate concentrate (BMAC) have all been suggested to restore joint congruity and minimize further chondral deterioration. However, chondrocyte implantation techniques and osteochondral grafts are technically challenging in the hip because of its constrained nature, and many cell-based therapies have shown suboptimal results near the chondrolabral junction because of the increased shear forces at the peripheral acetabulum and increased stress at the weight-bearing region of the joint. By using BMAC to augment labral repairs and coat chondrolabral junction breakdown, we are able to introduce mesenchymal stem cells to peripheral acetabular tissue with little to no drawbacks, while avoiding donor-site morbidity, open procedures, and multiple surgeries. The purpose of this Technical Note is to describe a reproducible method for harvesting, processing, and applying BMAC to the chondrolabral surface of the hip during hip arthroscopy without the need for donor-site morbidity or increased labral repair time.

Results of the reconstruction of the middle phalangeal base of the finger through an osteochondral autograft from the hamate bone

The fractured base of the middle phalanx was reconstructed in 13 patients using an osteochondral transplant from the carpometacarpal joint surface of the hamate bone. The goal was to restore joint stability with preservation of mobility. Indications were acute and missed isolated destruction of the palmar middle phalanx base ≥ 30 %. Contraindications were destruction of the head of the proximal phalanx, advanced chondropathy of the head of the proximal phalanx, and extensive soft tissue injury with loss of skin coverage for the proximal interphalangeal joint. In this procedure the fractured middle phalangeal base was debrided and the defect replaced by a size-matched autograft from the dorsal carpometacarpal osteoarticular surface of the hamate bone, which was secured in place with miniscrews. Bone fusion was achieved in 100 % with restoration of joint congruity in 12 of 13 cases and a slight subluxation in one case. Follow-up was possible in 9 cases after 23 (5-51) months. The average range of motion in the reconstructed joint for extension/flexion was 0/9/73°; grip strength was 82 % of the unaffected side. Five out of 9 patients developed a mild flexion contracture in the PIP joint. The DASH score was 6 (0-33) points, pain at rest was 1 (0-5), and pain at exercise 2 (0-6) on a visual analogue scale from 0-10. All patients were satisfied and willing to undergo the procedure again. According to the literature, reconstruction of the base of the middle phalanx by an osteochondral graft from the hamate bone is a reliable procedure to restore stability and mobility of the joint.

A prospective study of delta frame as external fixator for open-distal tibial fractures

Distal tibial fractures pose a serious challenge to the orthopaedician because muscular coverage is very less and poorly vascularized [1]. It is further complicated by comminution, joint involvement, open fractures and high energy trauma [1]. The goals of management are proper care of the injured soft tissues, restoration of joint congruity, stable fixation [2]. Ankle spanning external fixation ie Delta frame has become the initial treatment of choice for complex tibial pilon fractures [3]. The ‘tripolar configuration’ allows facilitation of wound care, plastic procedures and good xray or CT images [4]. The Delta external fixator was found to be the most stable external fixator for treating not stable as type III according AO/OTA’s classification [5]. The IM nails often do not provide enough stability in distal tibial fractures and plating requires extensive soft tissue dissection [6]. External fixators can also be used in osteoporotic and unreconstructable comminuted metaphyseal fractures with poor bone stock [6]. However literature support is scanty, hence we decided to do the above study with an aim to analyze its results using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot score.

Corrective Intra-articular Osteotomies for Tibial Plateau Malunion.

AbstractAnatomical reduction of the articular surface, restoration of mechanical axis, and containment of articular rim are the goals of the treatment of tibial plateau fractures, with an ultimate aim to restore joint congruity and stability. Tibial plateau malunions or nonunions are a result of a failed treatment. This article aims to review the most typical failure models and some strategies to overcome them by using joint preservation surgical techniques.

The Usefullness of Subtalar Arthroscopy in Surgical Treatment of Sanders Type 2 Calcaneal Fractures Using a Sinus Tarsi Approach

Category: Ankle, Trauma Introduction/Purpose: The sinus tarsi approach was designed to provide a direct view of the posterior facet and reduce soft tissue and neurovascular injuries. However, it is difficult to expose posterior facet using sinus tarsi approach because of limited surgical view. Confirmation of reduction status in intra-articular calcaneal fractures has traditionally been performed by intraoperative fluoroscopy such as Brodens view. Recently some reports indicate that there is a role for subtalar arthroscopy in these fractures. We thought that combination of intraoperative fluoroscopy and subtalar arthroscopy could more accurately restore joint congruity and provide better clinical outcomes. The purpose of this study was to clarify whether this combined checking has better clinical and radiological results comparing with intraoperative fluoroscopy only. Methods: Forty-five displaced calcaneal fractures involving the posterior facet were consecutively treated using a sinus tarsi approach by a single surgeon. Among them, 25 fractures were confirmed reduction of posterior facet by fluoroscopy (Fluoroscopy group) and 20 fractures were confirmed by combined fluoroscopy and subtalar arthroscopy (Arthroscopy group). Clinical evaluations were performed using the visual analogue scale (VAS) and the Ankle-Hindfoot Scale developed by the American Orthopaedic Foot and Ankle Society (AOFAS), and short form (SF)-36 v2 questionnaires. Radiographic evaluations were performed using calcaneal lateral radiographs and CT. Changes in Böhler’s angle were evaluated from the preoperative and last follow-up lateral radiograph of calcaneus. Reduction of the posterior facet was graded according to articular step, defect, and angulation of the posterior facet in CT. Results: There were no significant differences in terms of VAS, AOFAS score, and SF-36 v2 between Fluoroscopy and Arthroscopy groups at the last follow-up. No significant difference was observed in change of Böhler’s angles between the groups. Reduction of the posterior facet was graded excellent in 5 feet (20%), good in 12 (48%), and fair in 8 (32%) in Fluoroscopy group and excellent in 7 feet (35%), good in 11 (55%), and fair in 2 (10%) in Arthroscopy on postoperative CT. Screw penetration of posterior facet were observed in 4 feet of Fluoroscopy group and 1 foot of Arthroscopy group on postoperative CT. Conclusion: Subtalar arthroscopy appears to be useful in detecting joint incongrucencies in sinus tarsi approach of intra-articular calcaneal fractures.

A prospective study of surgical management of distal radius fracture in adult with plate fixation

Distal end radius fracture is one of the most common injuries and management of these fractures is still a challenge for orthopaedic surgeon in achieving good functional results. The present study was undertaken to assess the functional outcome of distal radial fractures in adults treated by plate fixation. All the patients were operated with open reduction and internal fixation with volar plate and screws with or without K-wire fixation. The functional outcome was assessed by demerit-point system of Gartland and Werley score. 8 (40%) patients had excellent results, 11 (55%) had good results, 1 (5%) patient had fair results and no patient had poor results. Distal end radius fractures treated by fixation with volar plate and screws or K-wire gives good result in terms of union, functional recovery and prevent stiffness. Open reduction and internal fixation provides best chance for restoring joint congruity and therefore patients treated by this method have a lesser chance of developing secondary osteoarthritis with minimal complications and is a better option for surgical management of these fractures.

Correction of Recurred Hallux Valgus Deformity by Endoscopic Distal Soft Tissue Procedure

The underlying reason for recurrence of hallux valgus deformity after bunion surgery is multifactorial and includes surgeon-based and patient-based factors as well as original components of deformity initially unaddressed at the index procedure. Surgical treatment of a recurred hallux valgus deformity should be undertaken using the same guidelines for correction of a primary hallux valgus deformity. It requires correction of bony alignment, restoration of joint congruity, and achievement of soft tissue balance. The purpose of this Technical Note is to describe the details of endoscopic soft tissue procedure to correct a recurred hallux valgus deformity. To successfully complete this procedure, adequate lateral release to achieve soft tissue balance around the first metatarsophalangeal joint with reduction of the sesamoid bones is mandatory.

Successful Strategies for Managing Monteggia Injuries.

Monteggia fracture-dislocations refer to traumatic ulnar fractures associated with proximal radioulnar and radiocapitellar joint instability. Careful clinical and radiographic evaluation of the entire limb in the acutely injured child is critical for timely diagnosis and appropriate treatment. Treatment principles include restoring and maintaining both ulnar length and alignment as well as radiocapitellar joint reduction. Recent information suggests that surgical treatment of acute injuries associated with complete ulnar fractures is safe and effective in maintaining bone and joint alignment. In cases of late presentation or missed diagnoses, chronic reconstruction may be considered in symptomatic patients with preserved radiocapitellar morphology. Although challenging, ulnar osteotomy and open joint reduction with or without ligament reconstruction may restore joint congruity in the majority of patients.

Evaluation of Hybrid External Fixator for Tibial Plateau Fractures: A Prospective Study

Background: Tibial plateau fracture is one of the common injuries encountered in our daily clinical practice. The goals of management of these peri-articular fractures are restoration of joint congruity by anatomic reduction of the articular fragments, stable fixation of fragments, early joint movements, care of injured soft tissues and prevention of fracture related, surrounding soft tissue and wound related complications. Though open reduction and internal fixation is preferred in the current day practice for such fractures, they are associated with a variety of complications leading to poor outcome. Ligamentotaxis and percutaneous fixation has been advocated by many authors to improve the results and to minimize the risk of serious complications. The aim of the present study is to evaluate and assess the results of closed reduction and hybrid external fixator application in the management of tibial plateau fractures. Materials and methods: Study included 28 patients with Schatzker type II and above closed tibial plateau fractures treated by Hybrid external fixator by the same team of surgeons on a tertiary care center following relevant investigations and assessment. Patients were followed up at regular intervals and finally evaluated clinically and radiologically at the end of one year. Conclusion: Our study highlighted the success of indirect reduction and hybrid external fixation application as the definitive method for the management of tibial plateau fractures. It minimizes the risk of soft tissue damage and reduces the incidence of serious complications with good fracture union and functional outcome in patients. Keywords: Hybrid external fixator, Tibial plateau fracture, Schatzker

Articular Cartilage Injury and Potential Remedies.

Osteoarthritis affects millions of people worldwide, is associated with joint stiffness and pain, and often causes significant disability and loss of productivity. Osteoarthritis is believed to occur as a result of ordinary "wear and tear" on joints during the course of normal activities of daily living. Posttraumatic osteoarthritis is a particular subset of osteoarthritis that occurs after a joint injury. Developing clinically relevant animal models will allow investigators to delineate the causes of posttraumatic osteoarthritis and develop means to slow or prevent its development after joint injury. Chondroprotectant compounds, which attack the degenerative pathways at a variety of steps, are being developed in an effort to prevent posttraumatic osteoarthritis and offer great promise. Often times, cartilage degradation after joint injury occurs despite our best efforts. When this happens, there are several evolving techniques that offer at least short-term relief from the effects of posttraumatic osteoarthritis. Occasionally, these traumatic lesions are so large that dramatic steps must be taken in an attempt to restore articular congruity and joint stability. Fresh osteochondral allografts have been used in these settings and offer the possibility of joint preservation. For patients presenting with neglected displaced intra-articular fractures that have healed, intra-articular osteotomy techniques are being developed in an effort to restore joint congruity and function. This article reviews the results of a newly developed animal model of posttraumatic osteoarthritis, several promising chondroprotectant compounds, and also cartilage techniques that are used when degenerative cartilage lesions develop after joint injury.

Hip reconstruction surgery is successful in restoring joint congruity in patients with cerebral palsy: long-term outcome.

Neurogenic hip dislocation is frequently observed in patients with cerebral palsy (CP). If the hip is not centred but not dislocated, the hip joint can be recentered with minor operative effort. Reconstructive procedures are indicated if the femoral head is subluxated or dislocated. There are no data as to when destruction of the femoral head requires a salvage procedure or whether hip reconstruction surgery is successful in restoring joint congruity in patients with CP. Our aim was to investigate femoral head plasticity after hip reconstruction surgery in a long-term outcome study. We studied a large cohort of patients with CP and high hip dislocation (Tönnis grade IV) before surgery. Sixty-eight patients were assessed, of whom 23 presented with bilateral high hip dislocation, and 91 complex hip reconstructions were conducted. Standardised radiographic examination was performed before and directly after surgery and at the long-term follow-up examination. Pain was the most frequent reason for complex hip-joint reconstruction (49 patients, 72%). An impressive improvement in pain was demonstrated postoperatively. Forty-five hip joints presented aspheric incongruity postoperatively, which improved on average 7.7 years after surgery and 59 hip joints showed congruency. Only 15% of patients experienced pain at the time of final follow-up, and that was of low intensity. Early conservative treatment for hip dislocation is helpful, and operative reconstruction should also be scheduled early. Continued surveillance is necessary, and Reimers index is useful for monitoring the development of hip centering. In case of hip pain and femoral head deformity, our long-term study indicates that hip reconstruction surgery as a part of multilevel surgery improves pain and function in patients with CP and Tönnis IV hip dislocation, even if the hip joint is incongruent after operation. This incongruity improves over the long-term. If possible, a reconstruction procedure should be performed before the femoral head becomes deformed. High plasticity of the hip joint suggest that even if the femoral head is deformed, hip reconstruction can be recommended.

Arthroscopic Treatment of Bucket-Handle Labral Tear and Acetabular Fracture

Traumatic hip dislocations are associated with chondral and labral pathology as well as loose bodies that can be incarcerated in the joint. These types of injury often lead to traumatic arthritis. In some cases an osseo-labral fragment may become incarcerated in the joint that is not readily visualized preoperatively. In place of open surgery, hip arthroscopy permits a technique to remove loose bodies and repair labral tears to restore joint congruity and achieve fracture reduction and fixation.