1/65. Spontaneous or traumatic premature closure of the tibial tubercle. A premature closure of the physis of the tibial tubercle in a young man has given rise to a shortening of the tibia, a patella alta and a reversed tibial slope of 20 degrees with clinical genu recurvatum. After a proximal open wedge tibial osteotomy all three postural deformities could be restored. The etiology of this complex deformity is discussed. ( info) |
2/65. Recurrent traumatic dislocation of the hip joint at the age of 13 and 17 years. A case report. We report a case of a recurrent traumatic dislocation of the hip joint in a young man at the age of 13 and 17. The patient had retroversion of the femoral neck, instead of a physiological anteversion. We found no consensus about the management of a recurrent traumatic dislocation of the hip joint in the literature. The various therapeutic options are discussed. We advised posterior capsulorraphy with femoral rotation osteotomy. The patient refused surgery. ( info) |
3/65. Chondritis dissecans of concave articular surfaces (acetabulum and glenoid fossa). Two case reports. We report two patients who had chronic mechanical pain due to substantial cartilage defects documented by arthrography. One of these patients had pain in the hip and declined surgical treatment. The other had pain in the glenohumeral joint; surgery found a fissure in the glenoid fossa cartilage and provided prompt pain relief. These two cases serve as reminders that investigation of the cartilage and subchondral bone in young patients with mechanical pain should not be confined to the convex articular surfaces, although these are more likely to sustain trauma-related damage than concave surfaces. In both our patients, the diagnosis required thin-section computed arthrotomography. ( info) |
| The authors present a case of pseudotumoral osteochondromatosis of the hip, interesting for its clinical and radiological features. They discuss the incidence of the sport in the pathogenesis of the loose bodies and the magnetic resonance findings. ( info) |
5/65. Traumatic posterior dislocation of hip in children. Traumatic posterior dislocation of the hip joint in children is an uncommon injury. It constitutes a true orthopedic emergency. It makes up over 80% of pediatric hip dislocations. In children, it can occur as a result of minimal trauma, which is attributed to a soft pliable acetabulum and ligamentous laxity. In skeletally mature adolescents, a greater force is required to dislocate the hip joint. Delay in reduction is associated with long-term complications such as avascular necrosis and degenerative arthritis. Avascular necrosis is related to the duration of dislocation. A poorer prognosis is associated with delay in reduction beyond 6 hours, advanced skeletal maturity, or multiple traumas. Prompt reduction minimizes complications. We report two cases of traumatic posterior dislocation of hip in children aged 3 and 14 years. Both were reduced within 6 hours of dislocation, and review at 6 months revealed normal examination and no evidence of any post-traumatic changes. Post-reduction treatment remains without a consensus. This review highlights the clinical presentation, management, and time-sensitive complications of the injury. ( info) |
6/65. Luxatio erecta of the hip. An interesting case report. This is a case report of an inferior dislocation of the hip in a 5 1/2-year-old child, characterized by acute flexion with slight abduction of the hip and flexion of the knee. The dislocation is reducible by traction in a cephalad direction, gradual extension and internal rotation of the hip. ( info) |
| The current literature offers only sparse reports of the use of hip arthroscopy in the pediatric patient injured during athletics. In contrast, the role of this technique in the diagnosis and treatment of multiple childhood hip conditions including pyarthrosis, legg-calve-perthes disease, slipped capital femoral epiphysis, coxa vara, juvenile chronic arthritis, chondrolysis, and avascular necrosis is well described. The application of this relatively uncommon technique to the young athlete has only recently become more attractive. The ability to examine and treat traumatic intra-articular pathology with minimal morbidity and prompt recovery is mandated by the young age of these patients and their demanding activity levels. Hip arthroscopists are now beginning to correlate preoperative physical exam findings and history with diagnosis and expectations for outcome. As our combined experience with this technique grows, the specific indications for its use in the young athlete become increasingly better defined. In pediatric and adolescent patients, the new onset of hip pain should warrant a high level of suspicion for the more common causes of pain such as infection, legg-calve-perthes disease, slipped capital femoral epiphysis, or developmental dysplasia. When these have been evaluated, further differential diagnosis should include labral tears, loose bodies, synovitis, and chondral lesions. As this review begins to elucidate, these conditions are amenable to arthroscopic evaluation and treatment. At this time, the presence of reproducible mechanical symptoms after a twisting or axial loading injury during athletics should prompt the orthopaedic surgeon to consider arthroscopic examination of the hip if conservative therapy fails. Satisfying and reproducible results have been achieved when using hip arthroscopy within these parameters. ( info) |
8/65. Acetabular labral tears in the athlete. Pathologic involvement of the acetabular labrum is an increasingly recognized phenomenon. athletes involved in sports that require repetitive twisting or who suffer trauma to the hip are at risk of injury to the acetabular labrum. Injury mechanisms that include hyperextension, hyperflexion, or extremes of abduction place the labrum at particular risk. Symptoms may be acute in onset or, more commonly, insidious onset with persistence or escalation of symptoms. The orthopaedic surgeon evaluating patients with sports-related hip injuries needs to remain cognizant of intraarticular injuries within the hip and, in particular, injuries to the acetabular labrum. Further investigation is needed to fully define the functional importance of the acetabular labrum. Arthroscopic management has been successful in evaluation and management of acetabular labral tears. ( info) |
9/65. Lateral impact injury. A source of occult hip pathology. arthroscopy has helped greatly in understanding the nature of many intra-articular disorders of the hip. It also has provided a better understanding of the pathomechanics and natural progression. This knowledge has aided in improving interpretative clinical skills and investigative techniques. Isolated traumatic chondral injury can occur as a result of impact loading over the greater trochanter. There seems to be a particular propensity for this injury in young physically fit adult males apt to incur this type of blow as a consequence of sport or activity. Initially, this injury may appear innocuous with variable dysfunction. When present, arthroscopy can reliably discern the pathology and often result in significant symptomatic improvement. The long-term consequences of these lesions are still concerning. Although symptomatic improvement from arthroscopic intervention is encouraging, for some cases the long-term influence may only be the knowledge provided for counseling the patient. Nonetheless, arthroscopy can be valuable in both the assessment and management of chondral injuries. ( info) |
10/65. Circumferential pelvic antishock sheeting: a temporary resuscitation aid. Acute traumatic pelvic ring instability causes severe pain and associated hemorrhage. Circumferential pelvic sheeting provides patient comfort and noninvasive, rapid, and temporary pelvic ring stability. A bed sheet is readily available, inexpensive, easily applied around the pelvis, and disposable. ( info) |