Hüftgelenkarthroskopie nach Luxatio obturatoria

Abstract

Traumatic dislocation of the hip is a severe injury. Even in cases of an early uncomplicated repositioning there is a high risk of associated intra-articular injuries, such as lesions of the labrum, ruptures of the ligament of the head of the femur and loose bodies. The degree of damage caused by dislocation of the hip becomes apparent with a highly increased risk of developing postinjury osteoarthritis after dislocation of the hip. Some of the major intra-articular damage resulting from hip dislocation, e.g. loose bodies, can be detected by computed tomography and magnetic resonance imaging and can be effectively addressed by hip arthroscopy, thus aiming at reducing the acute symptoms and the risk of postinjury osteoarthritis. The force effect which causes dislocation of the hip can generate severe associated extra-articular injures as in the case described with an unstable fracture of the pelvis. This supplementary injury had to be considered while planning the operative therapy and rehabilitation. A patient presented after a traffic accident with a luxatio obturatoria on the right side and a complex fracture of the left pelvis including the posterior ring and the anterior wall of the acetabulum. After reposition of the right hip and operative therapy of the left side, a loose body was identified in the right hip joint during the computed tomography control of the osteosynthesis. Before patient mobilization extraction of the intra-articular loose body was performed arthroscopically. This was done in consideration of the reduced possibility of distraction due to the osteosynthesis on the contralateral side. Attention was particularly paid to the risk of intra-abdominal fluid extravasation (IAFE). This syndrome is described as a severe complication during hip arthoscopy especially in cases of defects of the hip capsule as assumed after hip dislocation and magnetic resonance imaging.

Is It Safe to Perform an Early Arthroscopy After a Traumatic Hip Dislocation With an Associated Pelvic Ring Injury? Report of Our Technique

“…To the best of our knowledge, there is only one case report of hip arthroscopy performed early after an accident involving hip dislocation and pelvic ring fracture, even though in that case the pelvic ring injury was treated with osteosynthesis prior to arthroscopy. 5 With the technique that we describe, no complication in the pelvic fracture was noticed after hip arthroscopy provided that the pelvis is stable under traction testing.…”

“… 4 As for the pelvic ring fracture, the use of traction on the lower limbs to access the central compartment may displace fractures and exasperate the pelvic instability. 5 …”