CC BY 4.0 · European J Pediatr Surg Rep. 2018; 06(01): e43-e47
DOI: 10.1055/s-0038-1661408
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Arthroscopic Treatment of a Posterior Labral Interposition after a Pediatric Hip Dislocation—A Case Report

Christiane Kruppa
1   Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany
,
Marcel Dudda
2   Department of Orthopaedics and Traumatology, Universitatsklinikum Essen, Essen, Nordrhein-Westfalen, Germany
,
Thomas A. Schildhauer
1   Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany
,
Dominik Seybold
1   Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany
› Author Affiliations
Further Information

Publication History

13 January 2018

24 May 2018

Publication Date:
13 July 2018 (online)

Abstract

We report the case of a 13-year-old boy, who suffered a posterior hip dislocation from playing soccer. Closed reduction was performed urgently. Because of a nonconcentric hip after closed reduction, further imaging was done. An intra-articular bony fragment was identified. Arthroscopic treatment was performed. Through an anterior portal we were able to locate the intra-articular bony fragment, which was located within the region of the fovea. After lifting of the caudal enfolded labral complex, we were able to remove the fragment. Evidence of a grade 3 cartilage defect was present at the femoral head. We were able to reduce the enfolded posterior labral complex, which was stable afterwards without the necessity of additional suture fixations. The concentric hip reduction was confirmed on an anteroposterior view of the hip postoperatively. The patient was instructed to toe tip weight-bearing for 6 weeks with limited range of motion to 60° of hip flexion. Eight weeks after surgery, he was free of pain and discomforts. From our experience, the arthroscopic intervention after pediatric hip dislocation associated with intra-articular bony fragments or posterior labral complex injuries, represents to be a preferred minimally invasive method in contrast to open surgical procedures.

 
  • References

  • 1 Chun KA, Morcuende J, El-Khoury GY. Entrapment of the acetabular labrum following reduction of traumatic hip dislocation in a child. Skeletal Radiol 2004; 33 (12) 728-731
  • 2 Nepple JJ, Schoenecker PL, Clohisy JC. Treatment of posttraumatic labral interposition with surgical hip dislocation and labral repair. Iowa Orthop J 2011; 31: 187-192
  • 3 Blanchard C, Kushare I, Boyles A, Mundy A, Beebe AC, Klingele KE. Traumatic, posterior pediatric hip dislocations with associated posterior labrum osteochondral avulsion: recognizing the acetabular “Fleck” sign. J Pediatr Orthop 2016; 36 (06) 602-607
  • 4 Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 2001; 83 (08) 1119-1124
  • 5 Podeszwa DA, De La Rocha A, Larson AN, Sucato DJ. Surgical hip dislocation is safe and effective following acute traumatic hip instability in the adolescent. J Pediatr Orthop 2015; 35 (05) 435-442
  • 6 Ilizaliturri Jr VM, Gonzalez-Gutierrez B, Gonzalez-Ugalde H, Camacho-Galindo J. Hip arthroscopy after traumatic hip dislocation. Am J Sports Med 2011; 39 (Suppl): 50S-57S
  • 7 Roy DR. Arthroscopy of the hip in children and adolescents. J Child Orthop 2009; 3 (02) 89-100
  • 8 Morris AC, Yu JC, Gilbert SR. Arthroscopic treatment of traumatic hip dislocations in children and adolescents: a preliminary study. J Pediatr Orthop 2017; 37 (07) 435-439
  • 9 Jayakumar P, Ramachandran M, Youm T, Achan P. Arthroscopy of the hip for paediatric and adolescent disorders: current concepts. J Bone Joint Surg Br 2012; 94 (03) 290-296
  • 10 Kashiwagi N, Suzuki S, Seto Y. Arthroscopic treatment for traumatic hip dislocation with avulsion fracture of the ligamentum teres. Arthroscopy 2001; 17 (01) 67-69
  • 11 Wylie JD, Abtahi AM, Beckmann JT, Maak TG, Aoki SK. Arthroscopic and imaging findings after traumatic hip dislocation in patients younger than 25 years of age. J Hip Preserv Surg 2015; 2 (03) 303-309
  • 12 Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br 1961; 43-B: 752-757
  • 13 Mayer SW, Stewart JR, Fadell MF, Kestel L, Novais EN. MRI as a reliable and accurate method for assessment of posterior hip dislocation in children and adolescents without the risk of radiation exposure. Pediatr Radiol 2015; 45 (09) 1355-1362
  • 14 Rubel IF, Kloen P, Potter HG, Helfet DL. MRI assessment of the posterior acetabular wall fracture in traumatic dislocation of the hip in children. Pediatr Radiol 2002; 32 (06) 435-439
  • 15 Hwang JM, Hwang DS, Lee WY, Noh CK, Zheng L. Hip arthroscopy for incarcerated acetabular labrum following reduction of traumatic hip dislocation: three case reports. Hip Pelvis 2016; 28 (03) 164-168
  • 16 Roy DR. The use of hip arthroscopy in the management of the pediatric hip. J Hip Preserv Surg 2015; 3 (02) 97-107
  • 17 Kocher MS, Kim YJ, Millis MB. , et al. Hip arthroscopy in children and adolescents. J Pediatr Orthop 2005; 25 (05) 680-686
  • 18 Philippon MJ, Patterson DC, Briggs KK. Hip arthroscopy and femoroacetabular impingement in the pediatric patient. J Pediatr Orthop 2013; 33 (Suppl. 01) S126-S130
  • 19 Philippon MJ, Kuppersmith DA, Wolff AB, Briggs KK. Arthroscopic findings following traumatic hip dislocation in 14 professional athletes. Arthroscopy 2009; 25 (02) 169-174
  • 20 Ong C, Hall M, Youm T. Surgical technique: arthroscopic treatment of heterotopic ossification of the hip after prior hip arthroscopy. Clin Orthop Relat Res 2013; 471 (04) 1277-1282
  • 21 Alaia MJ, Patel D, Levy A. , et al. The incidence of venous thromboembolism (VTE)--after hip arthroscopy. Bull Hosp Jt Dis (2013) 2014; 72 (02) 154-158