Potential contribution of femoroacetabular impingement to recurrent traumatic hip dislocation

Abstract

A 16-year-old boy sustained a traumatic posterior dislocation of the right hip. After initial closed reduction, the hip spontaneously redislocated within 2 days. Four days after the initial dislocation, the patient was transferred to the authors' institution, where a radiographic workup showed a severe capsular and labral disruption from the posterior aspect of the acetabulum. Subsequently, the patient underwent operative treatment using the technique of surgical hip dislocation through a digastric osteotomy as described by Ganz. Using this approach, the avulsed capsulolabral complex as well as the pathological head-neck junction, which is suspected to be a lever for the femoral head, could be fully addressed. The authors recommend further radiographic studies to evaluate the underlying pathology in traumatic dislocation of the hip as well as the described surgical approach, which leads to successful treatment of the entire pathology.

Reply to the Letter to the Editor

“…In conclusion, the data in our study matches the theory of the case report [2], and is concordant with other publications [1,3]. The case report neither reports an original …”

Microinstability of the Hip and the Splits Radiograph

“…18 In an exclusively athletic population with low-energy subluxation or dislocation and posterior acetabular rim fracture, cam and/or pincer impingement has been identified in 64% to 82% of subjects. [19][20][21] Athletes with larger degrees of motion (eg, dancers, gymnasts) ( Figure 1) may have impingement-induced instability without abnormal cam or pincer deformities. In a cohort of 59 professional ballet dancers, only 1 hip had evidence of a cam deformity, whereas several other abnormalities were identified on magnetic resonance imaging because of a dynamic "pincer" mechanism from the extreme motion involved with their activity (or extraarticular impingement).…”

MRI as a reliable and accurate method for assessment of posterior hip dislocation in children and adolescents without the risk of radiation exposure

“…Failure to achieve a concentric reduction of the hip after closed reduction has been reported in up to 25% of the cases [2]. Most often, failure to achieve a concentric reduction is caused by intra-articular interposition of soft tissues, including the acetabular labrum and osteochondral fragments from the femoral head [2][3][4][5][6][7][8]. Therefore, imaging evaluation after closed reduction is mandatory in order to assess the concentricity of the reduction, identify potential damaged hip structures and plan for treatment accordingly.…”