Disastrous triad of femoral head:femoral neck fracture meeting fracture-dislocation of femoral head / 中国骨伤

Femoral head and ipsilateral femoral neck fractures are serious and complicated injuries, which usually yield unsatisfactory results using conventional hip-preserving surgery. The key point of the management and prognosis mainly lies in femoral neck fractures. An apparent and consecutive relationship exists between femoral neck fractures and femoral head fracture-hip dislocation in such injuries. It is believed that disastrous triad of femoral head (DTFH) could summarize these specific injuries, and reflect the injury mechanism and prognostic characteristics. Based on our clinical observation and literature review, DTFH could be divided into three subgroups:TypeⅠ, common DTFH, in which femoral neck fractures occur following femoral head fractures-hip dislocation due to the same trauma; TypeⅡ, iatrogenic DTFH, in which femoral neck fractures come out in the caring process of femoral head fractures-hip dislocation; Type Ⅲ, stressed DTFH, in which femoral neck fractures occur after the management of femoral head fractures-hip dislocation. In the scenario, the line of femoral neck fractures locates distally to the femoral head fractures. Herein, we will discuss clinical characteristics of these types of DTFH.

Luxación de cadera asociada a fractura del extremo proximal de fémur: reporte de caso y revisión del tema / Hip dislocation associated with fracture of the proximal end of the femur: case report and literature review / Luxação do quadril associada a fratura da extremidade proximal do fêmur: relato de caso e revisão da literatura

Las luxaciones traumáticas de cadera son poco frecuentes, y es excepcional la asociación lesional con fracturas del extremo proximal de fémur, habitualmente producidas por accidentes de alta energía. Un correcto diagnóstico, y tratamiento adecuado de la fractura, es la conducta ideal para disminuir las complicaciones. Presentamos el caso de un paciente masculino 49 años trabajador de la construcción que, en un accidente de tránsito, sufre una luxación de cadera asociado a fractura de cuello femoral, con excepcional presentación radiológica, con lesión del nervio CPE (ciático poplíteo externo), en que se realizó artroplastia total de cadera, con buena evolución y rehabilitación, retornando a su actividad laboral a los 11 meses del accidente. A propósito de este caso, realizamos una revisión bibliográfica para evaluar el tratamiento propuesto, el ideal, y pronóstico funcional de estas lesiones.

Traumatic hip dislocations are rare, and associated injuries involving fractures of the proximal end of the femur, usually as a result of high-energy accidents, are exceptional. A correct diagnosis and adequate treatment of the fracture is the most appropriate way to reduce complications. We present the case of a 49-year-old male construction worker who, as a result of a traffic accident, suffers from a hip dislocation associated with a femoral neck fracture, with exceptional radiological presentation, with injury to the EPS (External Popliteal Sciatic) nerve. Total hip arthropathy was performed, with good evolution and rehabilitation, and patient returned to work 11 months after the accident. In this particular case, we carried out a bibliographic review to evaluate the proposed treatment, the ideal treatment, and the functional prognosis of these injuries.

As luxações traumáticas do quadril são raras, e a associação de lesão com fraturas da extremidade proximal do fêmur, geralmente causada por acidentes de alta energia, é excepcional. O diagnóstico correto e o tratamento adequado da fratura é a abordagem ideal para reduzir as complicações. Apresentamos o caso de um operário da construção civil, 49 anos, que, em acidente de trânsito, sofre luxação de quadril associada a fratura do colo do fêmur, com apresentação radiológica excepcional, com lesão do nervo ciático poplíteo externo (CPE), em onde foi realizada a artroplastia total do quadril, com boa evolução e reabilitação, retornando ao trabalho 11 meses após o acidente. Em relação a este caso, realizamos uma revisão bibliográfica para avaliar o tratamento proposto, o ideal e o prognóstico funcional dessas lesões.

Research status of acetabular reconstruction in Crowe type Ⅱ and Ⅲ developmental dysplasia of the hip / 中国骨伤

Developmental dysplasia of the hip (DDH) is a major cause of hip arthritis and ultimately total hip arthroplasty. Due to the dysplastic acetabulum, how to place the acetabular cup becomes a challenge in acetabular reconstruction for such patients. Especially in the acetabula classified as Crowe typeⅡand type Ⅲ, the dislocation of the femoral head causes bone defects above the true acetabulum, which will affect the stability of the acetabular cup when the acetabular reconstruction is performed at the true acetabulum. Many acetabular reconstruction methods such as bone grafting, the use of small acetabular cups, socket medialization technique, and high hip center technique are used to increase the host bone coverage of the cup. However, each method has its own shortcomings that can not be ignored so that there is no unified conclusion on the acetabular reconstruction methods for Crowe typeⅡand type Ⅲ hip dysplasia. This article summarized and evaluated various reconstruction methods in combination with the acetabular morphology of DDH, and put forward the research direction in the future.

Obturator dislocation of total hip arthroplasty with disassembly of the prosthesis components and periprosthetic fracture in morbid obese patient / Luxación obturatriz de una prótesis total de cadera con desensamblaje de los componentes y fractura periprotésica en un paciente obeso

Abstract: Introduction: Anterior dislocation is a rare complication of total hip arthroplasty (THA). There exist only three cases in the literature. None of them report disassembly of the prosthesis components. We present a morbidly obese woman who suffered an irreducible obturator dislocation of an infected total hip arthroplasty (THA), due to uncontrolled adduction during an early debridement surgery. Following unsuccessful closed reduction attempts, a Vancouver B2 periprosthetic fracture and disassembly of the prosthetic components were observed. Two-stage revision THA was necessary to resolve the infection and restore hip functionality. In obturator dislocation, the femoral head prosthetic can be trapped in the obturator foramen, and this may disassemble the prosthesis components during reduction maneuvers; there's also risk of periprosthetic fracture. This mandate an open reduction of the joint. Patient obesity could be a determining factor for this rare type of hip arthroplasty dislocation. Obturator dislocation is an extremely rare complication of the total hip arthroplasty, whose reductions should be handled with caution given the risks of periprosthetic fractures. In most cases, an open reduction of the joint is required. Clinical importance: Our work is likely to be of great interest because it offers tips for the management of this rare complication based on our experience.

Resumen: Introducción: La luxación anterior es una complicación poco frecuente de la artroplastia total de cadera (ATC). Sólo existen tres casos en la literatura. Ninguno de ellos informa del desmontaje de los componentes de la prótesis. Presentamos el caso una mujer obesa que sufrió una luxación irreducible de una artroplastia total de cadera (THA), la cual estaba infectada, debido a la aducción no controlada durante una cirugía de desbridamiento temprano. Después de los intentos fallidos de reducción cerrada, se presentó una fractura periprotésica clasificada como Vancouver B2 y el desmontaje de los componentes protésicos. Ameritó cirugía de revisión en dos etapas, lo cual se realizó para resolver la infección y restaurar la funcionalidad de la cadera. En la luxación obturatriz, la cabeza femoral puede quedar atrapada en el agujero obturador y, como consecuencia, favorecer la disociación de los componentes protésicos al intentar la reducción, asimismo puede favorecer un brazo de palanca que produzca una fractura periprotésica. La obesidad puede ser un factor determinante para la producción de esta rara complicación. Por todo lo anterior, se recomienda considerar de entrada la reducción abierta. La luxación obturatriz es una complicación rara en la artroplastia total de cadera; su tratamiento puede ser difícil y asociarse a fracturas. La relevancia de este caso es que permite mostrar algunas estrategias de manejo para prevenir complicaciones catastróficas.

Strategy of acetabular anteversion in total hip arthroplasty with lumbar degenerative kyphosis / 中国骨伤

OBJECTIVE@#To investigate how to place the anteversion of acetabular prosthesis more reasonably in patients with lumbar degenerative kyphosis.@*METHODS@#A total of 122 patients with degenerative kyphosis of lumbar spine who underwent total hip arthroplasty from December 2017 to October 2019 were included and divided into experimental group and control group, 61 cases in each group. In experimental group, there were 25 males and 36 females, with a median age of 67.0 years;the median course of disease was 46.0 months;the functional pelvic plane with acetabular anteversion was set according to different types of pelvic anterior plane bracket. In control group, there were 27 males and 34 females, with a median age of 67.0 years;the median course was 42.0 months;in control group, the anteversion was set by the traditional method. The patients were followed up for 3 months. The operation time and blood loss were recorded. The incidence of infection and dislocation within 3 months was counted. Harris score before and 3 months after operation was recorded. Functional anteversion angle of standing position was measured 3 months after operation.@*RESULTS@#Compared with control group, there was no difference in operation time and blood loss between the two groups (P=0.918, 0.381);there was no infection between two groups within 3 months after operation;there was 1 case of hip joint dislocation in the control group and no dislocation in experimental group. There was no significant difference in Harris score before and after operation. Three months later, reexamination of pelvic standing radiographs showed that the number of patients with functional anteversion of acetabular prosthesis outside the safe area was less in experimental group thanin control group (@*CONCLUSION@#According to the preoperative evaluation and classification of patients, better functional anteversion of acetabular prosthesis can be obtained with the help of pelvic anterior plane reference bracket in hip arthroplasty with lumbar degenerative kyphosis.

Fractura iatrogénica de la cabeza femoral durante una reducción cerrada de luxación posterior de cadera. Reporte de un caso / Iatrogenic femoral head fracture during a closed reduction of posterior dislocation of hip. Case report

Resumen: La fractura luxación de la articulación coxofemoral es una lesión rara descrita de 4 a 17% de los casos por lo regular secundaria a accidentes automovilísticos. Generalmente de mal pronóstico y con complicaciones ya bien documentadas como la necrosis avascular de la cabeza femoral, la osteoartritis y la osificación heterotópica. La fractura iatrogénica del cuello o de la cabeza femoral es una complicación aún más rara cuya incidencia no está documentada en la literatura mundial. Como probables causas se tienen la irreductibilidad de una luxación de cadera al hacer más de un intento de manipulaciones cerradas, la ausencia de una adecuada anestesia y la falta de relajación del paciente. Se presenta el caso de una paciente joven atendida en las primeras ocho horas posteriores al accidente con fractura iatrogénica de la cabeza femoral con seguimiento a 18 meses, haciendo énfasis en la importancia de realizar una reducción anatómica y fijación estable para obtener resultados favorables.

Abstract: The fracture dislocation of the hip is a rare lesion described up to 4 to 17% of the cases and usually secondary to automobile accidents. Generally of poor prognosis and with already well documented complications such as avascular necrosis of the femoral head, osteoarthritis and heterotopic ossification. The iatrogenic fracture of the neck or head of the proximal femur is a complication even more rare and is not documented its incidence in the world literature. Having as probable causes the irreducibility of a dislocation of hip, more than one attempt of closed reduction, inadequate technique and some problems with the anesthesia and relaxation of the patient. We present the case of a young patient attended in the first eight hours after his accident with an iatrogenic fracture of the femoral head with follow up to 18 months and emphasizing the importance of making an anatomic open reduction and stable fixation in order to get favorable results.

Hip dislocation in cerebral palsy: evolution of the contralateral side after reconstructive surgery / Luxação do quadril na paralisia cerebral: a evolução do lado contralateral após cirurgia reconstrutiva

OBJECTIVE:To evaluate the progression of the contralateral hip after unilateral reconstruction of hip dislocation in patients classified as GMFCS IV-V; and to identify potential prognostic factors for their evolution.METHODS:This was a retrospective study on 17 patients with spastic cerebral palsy, who were classified on the GMFCS scale (Gross Motor Functional Classification System) as degrees IV and V, and who underwent unilateral reconstruction surgery to treat hip dislocation (adductor release, femoral varus osteotomy and acetabuloplasty). The minimum postoperative follow-up was 30 months. The clinical parameters evaluated were sex, age at time of surgery, length of follow-up after surgery and range of abduction. The treatment parameters were use/nonuse of femoral shortening, application of botulinum toxin and any previous muscle releases. The radiographic parameters were Reimer's extrusion index (REI), acetabular angle (AA) and the continuity of Shenton's line...

OBJETIVO:Avaliar a evolução do quadril contralateral após a reconstrução unilateral de luxação de quadril em pacientes classificados como GMFCS IV-V e identificar possíveis fatores prognósticos da evolução.MÉTODOS:Estudo retrospectivo de 17 pacientes portadores de paralisia cerebral espástica, classificados pela escala GMFCS (Gross Motor Functional Classification System) em graus IV e V, submetidos a cirurgia de reconstrução unilateral de luxação de quadril (liberação de adutores, osteotomia varizante femoral e acetabuloplastia). O seguimento pós-operatório mínimo foi de 30 meses. Foram avaliados parâmetros clínicos (sexo, idade na ocasião do procedimento cirúrgico, tempo de seguimento após a cirurgia e amplitude de abdução), de tratamento (a feitura ou não de encurtamento femoral, aplicação de toxina botulínica e se houve procedimentos musculares prévios) e radiográficos (índice de extrusão de Reimers [IR], ângulo acetabular [AC] e continuidade do arco de Shenton [AS])...

Usefulness of Arthroscopic Treatment of Painful Hip after Acetabular Fracture or Hip Dislocation

BACKGROUND: Painful hip following hip dislocation or acetabular fracture can be an important signal for early degeneration and progression to osteoarthritis due to intraarticular pathology. However, there is limited literature discussing the use of arthroscopy for the treatment of painful hip. The purpose of this retrospective study was to analyze the effectiveness and benefit of arthroscopic treatment for patients with a painful hip after major trauma. METHODS: From July 2003 to February 2013, we reviewed 13 patients who underwent arthroscopic treatment after acetabular fracture or hip dislocation and were followed up for a minimum of 2 postoperative years. The degree of osteoarthritis based on the Tonnis classification pre- and postoperatively at final follow-up was determined. Clinical outcomes were evaluated using visual analogue scale for pain (VAS) and modified Harris hip score (MHHS), and range of motion (ROM) of the hip pre- and postoperatively at final follow-up. RESULTS: There were nine male and four female patients with a mean age at surgery of 28 years (range, 20 to 50 years). The mean follow-up period of the patients was 59.8 months (range, 24 to 115 months), and the mean interval between initial trauma and arthroscopic treatment was 40.8 months (range, 1 to 144 months). At the final follow-up, VAS and MHHS improved significantly from 6.3 and 53.4 to 3.0 and 88.3, respectively (p = 0.002 and p < 0.001, respectively). However, there were no significant differences in hip flexion, abduction, adduction, external rotation, and internal rotation as minor improvements from 113.1°, 38.5°, 28.5°, 36.5°, and 22.7° to 118.5°, 39.0°, 29.2°, 38.9°, and 26.5° were observed, respectively (p = 0.070, p = 0.414, p = 0.317, p = 0.084, and p = 0.136, respectively). None of the patients exhibited progression of osteoarthritis of the hip at the final follow-up. CONCLUSIONS: Arthroscopic treatment after acetabular fracture or hip dislocation is effective and delays the progression of traumatic osteoarthritis.

New technique to overcome surgical pitfall during Chiari osteotomy

Chiari pelvic osteotomy is a salvage procedure, which aims mainly to achieve lateral coverage of femoral head in adolescents with acetabular dysplasia. The level of pelvic osteotomy is very important and crucial. It should be less than five mm from the joint space and directed with a cephalic inclination of 10° toward the sacroiliac joint. High-level osteotomy will create an undesired step between the femoral head and the new acetabulum. A new technique is described here to overcome an undesired step that was created by high level osteotomy in a 14 year old girl with residual acetabular dysplasia after surgically treated developmental dysplasia of the hip. The technique included distal transfer of the lateral part of the iliac bone without the need to dismantle the Chiari osteotomy and resulted in good outcome

Effects of intertrochanteric varus osteotomy on Norberg angle and percent coverage of the femoral head in displastic dogs

This study was conducted to assess the effects of femoral varus osteotomy on joint congruency in dogs affected by early stage hip dysplasia. Preoperative planning to move the femoral head within the acetabulum was carried out. Varisation of the femoral inclination angle (fIA) was achieved by Intertrochanteric Osteotomy (ITO). Norberg angle (NA), percent coverage (PC) of the femoral head by the acetabulum and fIA was measured from preoperative, immediate postoperative and first and second recheck radiographs of seven dogs that underwent an ITO (joint n = 9). There was significant (p < 0.05) improvement of both NA and PC in all patients as indicated by a change in the mean +/- standard deviation of 78.9degrees +/- 7.5 and 36.9% +/- 5.2 to 92.2degrees +/- 6.7 and 50.6% +/- 8.3, respectively. No significant difference (p < 0.05) was observed between the values of the planned femoral inclination angle (pfIA) of the femur and the effective femoral inclination angle (efIA) obtained after surgery (115.9degrees +/- 2.5 and 111.3degrees +/- 6.4, respectively). These findings could encourage the use of ITO in veterinary practice and indicate that intertrochanteric varus osteotomy should be re-considered for the treatment of early stage hip dysplasia in dogs with radiological signs of joint incongruency.

Experiencia inicial con la luxación controlada de cadera / Initial experience with surgical hip dislocation

Introducción: La luxación controlada de cadera es un abordaje quirúrgico que permite una amplia visualización del acetábulo, la cabeza y el cuello femoral. El objetivo del presente trabajo fue describir los resultados funcionales y las complicaciones obtenidos en nuestra institución. Materiales y métodos: Se incluyeron 16 caderas (13 pacientes) intervenidas entre enero de 2003 y enero de 2010. El promedio de edad fue de 31 años (r 11 a 55 años). La cirugía se indicó en los pacientes con pellizcamiento femoroacetabular (4), coxa profunda (4), epifisiólisis de cadera (5), condromatosis sinovial (1), lesión condral (1), necrosis focal de la cabeza femoral (1). Se analizaron los datos clínicos y radiográficos prequirúrgicos y posquirúrgicos. Resultados: Tres pacientes requirieron reemplazo total de cadera (RTC), uno por necrosis avascular (NAV) y dos por progresión de los síntomas. Siete pacientes presentaron buenos a excelentes resultados, dos regulares y cuatro pobres. Tres pacientes presentaron complicaciones mayores (NAV); dos de ellos fueron secuela de una epifisiólisis inestable severa. Las complicaciones menores fueron molestias en el trocánter mayor (2) y el aflojamiento de la osteosíntesis (1). Seis pacientes requirieron cirugías adicionales. Conclusiones: La luxación controlada de cadera, en nuestra experiencia inicial, mostró ser un abordaje demandante que requiere un minucioso conocimiento anatómico y una exacta selección de los pacientes, no exento de complicaciones mayores

Tratamiento quirúrgico de fractura de cabeza femoral mediante luxación controlada de cadera: resultados a mediano plazo / Surgical treatment through controlled hip dislocation for femoral head fractures: mid term results

Femoral head fractures associated to hip dislocations are uncommon lesions. Most reports present only short-term results. Objectives: To show functional outcome after a mid term follow up of patients with Pipkin II femoral head fractures treated operatively. Materials and Methods: A retrospective and descriptive evaluation of a 4 consecutive case series (four men, mean age of 36.5 years) treated operatively with an 89-month average follow up (range form 72-108 month). Controlled femoral head dislocation was performed in all patients and two 2.4 mm screws were used for fixation. At final follow up, the Harris Hip Score (HHS) and complications were assessed. Results: No immediate or late complications were reported. The mean HHS was of 95 points (range from 89 to 100 points).No signs of postraumatic arthritis or femoral head osteonecrosis were seen at the last radiographic assessment. Conclusion: in this series of patients with Pipkin II femoral head fractures mid-term functional results are good and no postraumatic arthritis or femoral head osteonecrosis were observed at final follow-up.

Las fracturas de cabeza femoral, asociada a luxación de cadera, corresponden a lesiones infrecuentes. La mayoría de los estudios reportan resultados a corto plazo. Objetivo: Describir el resultado funcional de pacientes con fractura Pipkin II operados con seguimiento a mediano plazo. Material y Métodos: Evaluación retrospectiva y descriptiva de una serie consecutiva de 4 pacientes (cuatro hombres, mediana de edad 36,5 años) operados con un seguimiento de mediana de 89 meses (72-108 meses). En todos los casos se realizó luxación controlada de la cabeza femoral y se utilizaron 2 tornillos de 2,4 mm. Se evaluaron complicaciones y Harris Hip Score (HHS) al último control clínico. Resultados: No se presentaron complicaciones tempranas ni tardías. El HHS promedio fue de 95 puntos (89-100 puntos). La última evaluación radiográfica no demostró signos de artrosis postraumática ni signos de necrosis avascular de cabeza femoral. Conclusión: En este grupo de pacientes con fractura de Pipkin tipo II los resultados funcionales a mediano plazo son buenos, no registrándose en el seguimiento artrosis de cadera postraumática ni necrosis avascular de la cabeza femoral.

Luxación de prótesis de cadera en el Servicio de Traumatología y Ortopedia del Hospital General del Este "Dr. Domingo Luciani" año 2000-2005 / Hip dislocation in the Departament of Traumatology and Orthopedic East Hospital General

El presente trabajo de investigación, es un estudio de tipo retrospectivo y descriptivo, de un período de seis años, comprendidos entre Enero 2000 a Diciembre del 2005, donde se estudiaron a todos los pacientes que fueron intervenidos quirúrgicamente de prótesis de cadera, en el servicio de Traumatología y Ortopedia ; obteniéndose un total de 240 pacientes, de estos, 10 pacientes presentaron luxación de prótesis, de las cuales 09 (90%) eran del sexo femenino y 01 (10%) masculinos, con una edad promedio de 62,8 años. La luxación apareció en 02 prótesis primaria y en 08 prótesis de revisión; 04 casos en Hemiartroplastia y 06 en Artroplastia Total de Cadera; según el Tiempo de aparición: Precoz 01 caso, Tardía 09 casos; según el número: Simple 09 casos, Recurrentes: 01 caso; Mecanismo de lesión: Traumáticos 04 casos, Espontáneos 06 casos; Tratamiento: conservador 05 casos, quirúrgico: 05 casos.

The present investigation, is a study of retrospective and descriptive type, of a period of six years, included of January 2000 to December of the 2005. All the patients of prothesis of hip in the service of orthopedic surgery was studied. Of a total of 240 patients, 10 presented luxation of prothesis, 9 corresponded feminine sex and 1 to masculine sex, the age average of 62.8 years. The dislocation happened in 2 primary prothesis, in 8 revision prosthesis, 4 of hemiartroplastia, and in 6 cases of total arthroplasty of hip. Acording to the time of appearance: precocious 1 case, delayed 9 cases. According to the number: simple 9 cases, appellants 1 case. Mechanism of injury: traumatic 4 cases, spontaneous 6 cases. Preservative treatment 5 cases, surgical 5 cases.

Application of Ganz Surgical Hip Dislocation Approach in Pediatric Hip Diseases

BACKGROUND: Ganz surgical hip dislocation is useful in the management of severe hip diseases, providing an unobstructed view of the femoral head and acetabulum. We present our early experience with this approach in pediatric hip diseases. METHODS: Twenty-three hips of 21 patients with pediatric hip diseases treated using the Ganz surgical hip dislocation approach were the subjects of this study. The average age at the time of surgery was 15.7 years. There were 15 male and 6 female patients who were followed for an average of 15.1 months (range, 6 to 29 months). Diagnoses included hereditary multiple exostoses in 9 hips, slipped capital femoral epiphysis in 7, Legg-Calve-Perthes disease in 4, osteoid osteoma in 1, pigmented villonodular synovitis in 1, and neonatal septic hip sequelae in 1. Medical records were reviewed to record diagnoses, principal surgical procedures, operative time, blood loss, postoperative rehabilitation, changes in the range of hip joint motion, and complications. RESULTS: Femoral head-neck osteochondroplasty was performed in 17 patients, proximal femoral realignment osteotomy in 6, open reduction and subcapital osteotomy for slipped capital femoral epiphysis (SCFE) in 2, core decompression and bone grafting in 2, hip distraction arthroplasty in 2, and synovectomy in 2. Operative time averaged 168.6 minutes when only osteochondroplasty and/or synovectomy were performed. Hip flexion range improved from a preoperative mean of 84.7degrees to a mean of 115.0degrees at the latest follow-up visit. Early continuous passive motion and ambulation were stressed in rehabilitation. No avascular necrosis of the femoral head was noted up to the time of the latest follow-up visit, except for in one SCFE patient whose surgical intervention was delayed for medical reasons. CONCLUSIONS: Ganz surgical hip dislocation provides wide exposure of the femoral head and neck, which enables complete and precise evaluation of the femoral head and neck contour. Hence, the extensive impinging bump can be excised meticulously, and the circulation of the femoral head can be monitored during surgery. The Ganz procedure was useful in severe pediatric hip diseases and allowed for quick rehabilitation with fewer complications.

Artroscopía de cadera y trauma articular: revisión bibliográfica a propósito de dos casos clínicos / Hip arthroscopy in articular trauma: bibliographic review of two cases

Although intra-articular lesions after hip trauma are frequent, reports of patients treated with hip arthroscopy are limited. The most common indications for this procedure are loose bodies, labral lesions and chondral lesions. Some of these patients may have preexisting femoroacetabular impingement. We present in this article two case reports of intra-articular lesions after traumatic hip dislocation. The first is a case of a man with an anterior labral lesion and loose bodies after closed hip reduction. The second case is a man with a large anterior labral lesion with a previous femoroacetabular impingement. Both of them were treated by debridement of unstable labrum. Additionally loose bodies removal was performed in the first patient and femoral head-neck osteochondroplasty in the second one with excellent clinical results. Hip arthroscopy has proven to be a safe and effective surgical technique for treating specific posttraumatic lesions and previous femoroacetabular impingement.

Son frecuentes las lesiones intraarticulares post-fractura o luxación de cadera siendo escasos los reportes de tratamiento artroscópico de estas lesiones. Las principales indicaciones son cuerpos libres intraarticulares, lesiones del labrum o lesiones condrales. Puede coexistir además una deformidad preexistente como el pellizcamiento femoroacetabular. Se presentan 2 casos clínicos de pacientes con lesiones intraarticulares después de una luxación de cadera. El primer caso con una lesión del labrum anterior y cuerpos libres intraarticulares después de la reducción cerrada. El segundo caso con una extensa lesión del labrum anterior además de un pellizcamiento femoroacetabular. Ambos fueron tratados mediante artroscopía de cadera realizándose la estabilización del labrum. Además, se realizó la extracción de los fragmentos libres y una osteocondroplastía femoral respectivamente, con una excelente evolución clínica. La artroscopía de cadera es una técnica efectiva y segura para el tratamiento de estas lesiones traumáticas y corrección de la deformidad preexistente en casos de pellizcamiento femoroacetabular.

Fratura-luxação traumática do quadril no futebol: relato de caso / Traumatic hip fracture-dislocation in soccer: a case report

De ocorrência rara no futebol, esporte coletivo mais praticado no mundo, as fraturas de acetábulo que se associam às luxações da articulação do quadril são lesões com grande potencial de gerar seqüelas graves e limitantes. O rápido atendimento, a precisão do diagnóstico e procedimentos de salvamento da articulação pela redução e correta fixação são essenciais para perspectiva de retomar a atividade física regular praticada anteriormente ou outra que se adapte à nova situação.

Uncommon in soccer, the world's most popular sport, the acetabular fractures with hip dislocation are injuries with high incidence of long-term serious sequelae. Prompt attending with accurate diagnosis and reduction and fixation are important to produce a stable and congruent joint for returning to the usual sports practice prior the injury.

Utilización de Anillo de polietileno en luxación recidivante de artoplastia total de cadera: método de salvataje / Use of polyethylene ring in luxación recidivante of total artoplastia of hip: salvataje method

El propósito de nuestro trabajo es revisar los casos de los pacientes complicados (pacientes con problemas renales, pacientes mayores de 75 años, pacientes con más de 5 revisiones o cardiópatas), con luxación recidivante de prótesis total de cadera con componentes sin signos de aflojamiento, a quienes se les ha intervenido quirúrgicamente y se les ha colocado un anillo de polietileno el cual se fija con tornillos a su antiguo inserto de plástico. Fue realizado un análisis retrospectivo de un grupo de 18 pacientes tratados en forma consecutiva en nuestra Unidad de Cirugía de Artritis y todos sus datos obtenidos de sus respectivas historias médicas de la clínica donde fueron llevadas a cabo las intervenciones. Fueron tratados quirúrgicamente y se les colocó un anillo de polietileno para reforzar el acetábulo y constreñir la articulación. Desde Febrero de 2001 hasta Marzo de 2006, han sido colocados 18 anillos de polietileno para el reforzamiento del componente del acetábulo en 18 pacientes como procedimiento de revisión en casos especiales de luxación recurrente de prótesis total de cadera. El abordaje realizado fue postero-lateral con artrotomía anterior en todos los casos. El promedio de duración en el seguimiento ha sido de 25 meses (rango de 1 a 65 meses) y la edad promedio de los pacientes al momento de la cirugía fue de 66 años de edad (36 a 82 años). Las diferentes indicaciones para el uso del anillo de polietileno fueron: Pacientes sanos mayores de 75 años del anillo de polietileno fueron: Pacientes sanos mayores de 75 años y componentes fijos (5 pacientes), Pacientes cardiópatas mayores de 75 años y componentes sin signos de aflojamiento (4 pacientes), pacientes con enfermedad renal (3 pacientes), pacientes con más de 5 revisiones y luxaciones recurrentes (1 paciente). Pacientes con ausencia del trocánter mayor y prótesis fija (5 pacientes).

Luxación qirúrgica de cadera en condromatosis sinovial. A propósito de un caso / Surgical dislocation of the hip in synovial chondromatosis. Case report

La condromatosis sonovial es un proceso beningo infrecuente que afecta las articulacione y otras estructuras que contienen tejido sinovial. Se presenta el caso de una mujer de 46 años con condromatosis sinovial sintomática de cadera derecha, en etapa inicial, localizada en la fosa acetabular. El tratamiento fue la resección abierta de la lesión mediante luxación quirúrgica de la cadera. No hubo complicaciones intra o postoperatorias y la osteotomía consolidó adecuadamente. Al último seguimiento, la paciente no tiene dolor y realiza una vida normal.