Arthroscopic Treatment of Traumatic Hip Dislocations in Children and Adolescents: A Preliminary Study
| Autor: | Andrew C Morris, Shawn R. Gilbert, Jonathan C. Yu |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Adolescent medicine.medical_treatment Avascular necrosis Avulsion 03 medical and health sciences Arthroscopy Fractures Bone 0302 clinical medicine Operative report Medicine Hip Dislocation Humans Orthopedics and Sports Medicine 030212 general & internal medicine Child Reduction (orthopedic surgery) Retrospective Studies 030222 orthopedics Labrum medicine.diagnostic_test business.industry Soft tissue General Medicine medicine.disease Surgery Radiography Open Fracture Reduction Pediatrics Perinatology and Child Health Hip Joint Hip arthroscopy business Tomography X-Ray Computed |
| Zdroj: | Journal of pediatric orthopedics. 37(7) |
| ISSN: | 1539-2570 |
| Popis: | Introduction Traumatic hip dislocations in children and adolescents require prompt concentric reduction. Incomplete reduction with or without retained osteochondral fragments has traditionally been addressed with open reduction. We report on the use of arthroscopy to remove loose bodies and reduce enfolded soft tissues to obtain concentric reduction in the pediatric and adolescent population. Specific note is made of underlying pathology and arthroscopic intervention. Methods After obtaining Institutional Review Board approval, we performed a retrospective review of patients under the age of 19 who were treated with hip arthroscopy following hip dislocation reduction at a single children's hospital from 2006 to 2013. Clinic notes, operative reports, radiographic images, and arthroscopic photographs were reviewed. Results Seven patients were identified (aged 8 to 17) who underwent hip arthroscopy after a posterior hip dislocation. Intra-articular bone fragments were found in 6 of 7 patients and 5 of 7 patients had an incongruent hip joint identified by imaging before surgery. The predominant pathology was avulsion of a small bony fragment attached to the posterior capsular labral soft-tissue complex, which became enfolded and blocked reduction (5 of 7 patients). In all cases, the enfolded soft tissue was reduced without soft tissue or bone repair. Additional loose osteochondral fragments were removed, and in 2 cases an avulsed ligamentum teres was debrided. Average follow-up was 10 months. No avascular necrosis or recurrent instability was identified in any case. Conclusions When incongruent hip joints were arthroscopically evaluated after traumatic dislocation, a consistent pattern of interposition of avulsed posterior bone fragment with attached capsule and labrum was found. Reduction of the capsulolabral complex without repair provided satisfactory short-term outcomes. Arthroscopic treatment of such cases was effective and well tolerated and could lead to considerably less postoperative pain and surgical morbidity than open surgical treatment. Level of evidence Level IV-case series. |
| Databáze: | OpenAIRE |
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