Traumatic dislocation of the hip with separation of the capital epiphysis: 5 adolescent patients with 3-9 years of follow-up

We reviewed 5 cases of type I epiphyseal fracture with dislocation of the femoral head from the acetabulum in adolescent patients. All children had an open reduction and screw fixation. In all cases, the femoral head developed avascular necrosis. The clinical result after a mean of 3-9 years' follow-up was good according to the Merle d'Aubigné-Postel scale. Despite necrosis, 2 heads developed spherically after treatment: one which had a primary physeal resection and fixation, the other after an autogenous bone graft in the screw track following removal of the screw.     

Spontaneous Regression of a Malignant Primary Bone Tumour

A histologically confirmed malignant, primary bone tumour in the pelvis, presumably an osteosarcoma, underwent spontaneous regression. The large tumour was inoperable and gave rise to severe pain as well as difficulty in walking. After 2 years of progression, with increasing destruction of the pelvic bones, the clinical and radiological condition improved spontaneously, and at present the patient is alive, almost symptom-free, after 6 years follow-up.     

Traumatic dislocation of the hip in adolescence with separation of the capital epiphysis. Two case reports

Fracture separation of the capital femoral epiphysis occurring during attempted closed reduction of a traumatic dislocation of the hip is described in two adolescents. Although this complication is extremely rare, the prognosis of fracture separation with dislocation of the epiphysis is known to be poor. Avascular necrosis subsequently developed in both cases. The importance of gentle manipulative reduction under general anaesthesia with complete muscle relaxation is emphasised.     

Traumatic dislocation of the hip with separation of the proximal femoral epiphysis

Summary Traumatic hip dislocation with separation of the proximal femoral epiphysis is a rare injury. Twenty-six observations collected from the literature, together with two further cases presented in this paper, were statistically evaluated. Two types of injury were considered: Tl, dislocation with complete separation and displacement of the epiphysis; and T2, dislocation with incomplete separation of the epiphysis. Two main therapeutic protocols had been carried out: restoration of anatomy, supplemented by different means of stabilization; and removal of the epiphysis with or without complementary procedures. Fifteen patients had been followed up for 2 years or more and avascular necrosis had been found in all of them. Leg-length discrepancy also had significant incidence. Eleven patients with T1 injury had been followed up to skeletal maturity: results were fair in four patients and poor in seven. Early surgical restoration of the proximal extremity of the femur, stabilized with Kirschner wires and cast, is the recommended treatment.

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Zusammenfassung Eine traumatische Hüfthuxation mit Hüftkopfepiphysenlösung ist eine seltene Verletzung. In der vorliegenden Arbeit werden 26 Beobachtungen aus der Literatur zusammen mit 2 weiteren, eigenen Beobachtungen ausgewertet. Es werden zwei Verletzungstypen unterschieden: Typ 1: Luxation mit kompletter Lösung und Abrutsch der Epiphyse und Typ 2: Luxation mit inkompletter Epiphysenlösung. Bei der Behandlung wurden in der Hauptsache 2 Wege eingeschlagen: Die anatomische Wiederherstellung der Verhältnisse am proximalen Femurende, ergänzt durch verschiedene Stabilisationsmethoden oder die Entfernung der Femurepiphyse mit oder ohne zusätzliche Maßnahmen. Bei 15 Patienten wurde der Verlauf 2 Jahre oder länger verfolgt; alle entwickelten eine avaskuläre Nekrose. Häufig traten auch Beinlängendifferenzen auf. 11 Patienten mit einer Typ 1-Verletzung wurden bis zur Skelettreifung beobachtet: Die Ergebnisse waren mäßig bei 4 Patienten and schlecht bei 7. Trotzdem wird die frühe chirurgische Wiederherstellung der anatomischen Verhältnisse am proximalen Femurende und die Stabilisierung mit Kirschner-Drähten und Gipsverband als Behandlungsmethode empfohlen.

     

Posterior dislocation of the hip associated with separation of the capital epiphysis. A case report

A 14-year-old boy with a posterior dislocation of the femoral head suffered an epiphyseal separation with reduction of the femoral neck into the acetabulum during an attempted closed reduction. He was treated by an open reduction with care taken not to damage the retinacular blood supply to the head. He did not develop avascular necrosis and is totally asymptomatic four years following his injury.     

Traumatic dislocation of the hip with separation of the proximal femoral epiphysis. Report of two cases and review of the literature

Traumatic hip dislocation with separation of the proximal femoral epiphysis is a rare injury. Twenty-six observations collected from the literature, together with two further cases presented in this paper, were statistically evaluated. Two types of injury were considered: T1, dislocation with complete separation and displacement of the epiphysis; and T2, dislocation with incomplete separation of the epiphysis. Two main therapeutic protocols had been carried out: restoration of anatomy, supplemented by different means of stabilization; and removal of the epiphysis with or without complementary procedures. Fifteen patients had been followed up for 2 years or more and avascular necrosis had been found in all of them. Leg-length discrepancy also had significant incidence. Eleven patients with T1 injury had been followed up to skeletal maturity: results were fair in four patients and poor in seven. Early surgical restoration of the proximal extremity of the femur, stabilized with Kirschner wires and cast, is the recommended treatment.     

保留骨骺灭活再植术治疗儿童股骨远端骨肉瘤

[目的]探讨保留骨骺灭活再植术的临床应用注意事项及并发症的防治。[方法]回顾6年间所治疗的11例患者,男5例,女6例。平均年龄7.6岁。均位于股骨下端。MRI分型:Ⅰ型7例,Ⅱ型4例。1例合并病理骨折。治疗方法均采用术前化疗2疗程 保留骨骺灭活再植手术 术后化疗。[结果]手术时间为3~4 h。术中出血量为300~500 ml。无血管、神经损伤。术后切口一期愈合,无切口感染及切口延迟愈合。11例获得随访10~72个月,患膝屈曲>110°3例,90°~110°3例,60°~89°4例,<60°1例。下肢等长4例,患肢较健侧短<2 cm 5例,2~3cm 2例。复发1例,转移2例,死亡3例,螺钉松动1例,灭活骨骨折1例。[结论]保留骨骺灭活再植术有利于术后功能恢复和肢体长度的保持;严格无瘤及无菌操作、彻底引流、适当延长外固定的时间、功能锻炼时注意保护肢体等是预防并发症发生的主要措施。     

Dislocation of the polyethylene liner in hip arthroplasty: 6 patients with dislocation within 3 years

We revised 6 patients with early destruction of the liner in a cementless press-fit acetabular cup. They had no signs of infection or evidence of trauma. The failures were probably due to rotation of the liner inside the metal shell and destruction of the polyethylene by the cutting edge of the metal. This early complication may be difficult to diagnose because of normal radiographs. We suggest that the manufacturer should provide the insert with a metal marker to make this complication easier to detect.     

Chondrolysis of the hip complicating slipped capital femoral epiphysis: long-term follow-up of nine patients

Nine patients with chondrolysis secondary to slipped capital femoral epiphysis of the hip were followed up from a minimum of 7 to a maximum of 19 years (average, 13.7 years) after the onset of the disease. The degree of slipping of the proximal epiphysis of the femur was severe in five patients and moderately severe in four patients. The nine patients were treated with non-weight bearing, antiinflammatory drugs, and physical therapy. The disease had a good resolution, with gradual regression of pain, and radiographs showed restoration of the joint space in an average of 10 months. At follow-up, mild coxalgia after prolonged activity was present in five patients, whereas in the one patient with concomitant avascular necrosis, pain was much more intense. All patients had some limitation of range of motion of the hip. It was most restricted in two patients, one with associated avascular necrosis and one with a severe slip. In all patients, radiographs showed restoration of the joint space. In the group with severe degrees of slipping, there were marginal osteophytes of the femoral head and the acetabulum. Significant arthrosis was present in the patient treated conservatively and in the patient with associated ischemic necrosis. In this long-term study of chondrolysis secondary to slipped capital femoral epiphysis, the overall prognosis was benign and was determined by the degree of slipping of the proximal epiphysis of the femur and concomitant aseptic necrosis. However, the authors believe that the patients with radiographic signs of degenerative joint disease may have a poor long-term prognosis.     

创伤性髋关节脱位的治疗及疗效观察

目的探讨创伤性髋关节脱位的治疗方法及疗效。方法对43例创伤性髋关节脱位的患者进行分型,前脱位、后脱位和中心性脱位分别为3例、36例、4例。其中36例后脱位按Thompso和Epstein分型:Ⅰ型4例,Ⅱ型15例,Ⅲ型7例,Ⅳ型3例,Ⅴ型7例。闭合复位21例,手术切开复位22例。结果术后随访1～5年,按MerledAubigne髋关节评分系统评分:优17例,良11例,中6例,可3例,差6例。术后股骨头缺血性坏死8例。结论创伤性髋关节脱位是致残率较高的创伤,早期的确诊和准确而稳定的复位是治疗创伤性髋关节脱位的关键。骨盆X线片上证实同心圆复位是必要的。延时复位可能导致股骨头缺血性坏死等并发症的发病率增高。     

Slipped capital femoral epiphysis after septic arthritis of the hip in an adolescent: report of a case.

Septic arthritis of the hip must be managed promptly to avoid the serious complications associated with the condition. In the case reported here, the diagnosis was delayed and was complicated by a slipped capital femoral epiphysis. The patient, an adolescent boy previously in good health, presented with a 2-week history of hip pain and systemic illness. Septic arthritis was diagnosed and was managed by incision and drainage and antibiotic therapy. Two weeks later he presented with a subcutaneous abscess and a slipped capital femoral epiphysis, which was pinned in situ. There was a 2.5-cm leg-length discrepancy. Avascular necrosis of the femoral head subsequently developed leaving the boy with a permanent disability.     

Traumatic dislocation of the hip with ipsilateral femoral shaft fracture: a method of treatment

Two cases of posterior fracture-dislocation of the hip associated with an ipsilateral femoral shaft fracture are presented with a technique of reduction and stabilization which allows for closed treatment of both injuries. This approach is advantageous in the severely injured patient.     

Lateral growth disturbances of the capital femoral epiphysis after nonoperative treatment of late developmental dislocation of the hip: thirty-five cases followed to skeletal maturity

The purpose of this study was to evaluate the effect of type 2 growth disturbances in the developing hip and compare it with other treated hips without evidence of growth arrest. Radiographic data of 117 children (155 hips) with late developmental dislocation of the hip treated by closed reduction at an average age of 14.9 months and followed to skeletal maturity were retrospectively reviewed. Depending on the presence of lateral growth disturbances, our patients were divided into 2 groups similar with regard to age and treatment methods. Lateral physeal arrest was evident at an average age of 8.9 years in 23% of these hips. Seventy-six percent of these hips with type 2 avascular necrosis were classified as Severin classes 1 and 2. One quarter of them had no deformity of femoral head, 8 had deformity of 2 mm or less, and 18 more than 2 mm. There was no statistical difference in satisfactory and unsatisfactory results or most parameters describing the acetabulum between the 2 groups. Lateral tilting of the proximal femoral epiphysis in most cases does not affect final radiologic results. It is a mild form of avascular necrosis and indications for secondary operative procedures are mostly related to natural history of the disease rather than to lateral physeal arrest.     

Traumatic anterior dislocation of the hip joint with fracture of the acetabulum: a case report

A 67-year-old woman sustained a pubic-type anterior dislocation of the hip associated with a comminuted fracture of the anterosuperior part of the acetabulum and the anteroinferior iliac spine following a fall on the knee. Because of interposition of the iliopsoas tendon, closed reduction followed by skeletal traction failed to achieve reduction of the acetabular fragment. An abnormally high degree of anteversion of the femoral neck is suggested as a possible predisposing factor in this injury.     

Traumatic anterior dislocation of the hip associated with ipsilateral femoral neck fracture: a case report

A thirty-nine-year-old female patient was brought to the emergency room following an automobile accident. Radiographic examination revealed a subcapital fracture of the left femur associated with anterior femoral head dislocation, and a contralateral comminuted femoral shaft fracture. Computed tomography showed that the acetabulum was empty, with the femoral head dislocated anteriorly close to the obturator foramen. Uncemented total hip arthroplasty and locked intramedullary nailing were performed on the left and right sides, respectively. Sixty-two months after surgery, she had no difficulty in performing daily activities.     

Prophylactic pinning of the contralateral hip in slipped capital femoral epiphysis : evaluation of long-term outcome for the contralateral hip with use of decision analysis

BACKGROUND: The risk of a contralateral slip in patients who are first seen with a unilateral slipped capital femoral epiphysis has been reported to be 2335 times higher than the risk of an initial slip. The overall prevalence of bilaterality varies widely throughout the literature, with some reports indicating rates as high as 80%. This finding has led many authors to recommend prophylactic pinning of the contralateral asymptomatic hip in patients presenting with a unilateral slipped capital femoral epiphysis. METHODS: A decision analysis model with probabilities for the occurrence of contralateral slip and for the severity of slip at different intervals of follow-up was used in the present study. These probabilities were compared with those for various outcomes when the contralateral hip is prophylactically pinned. Scores representing long-term outcome, according to the Iowa hip-rating system, were used in the model as a measure of utility. The probabilities of contralateral slip and the rates of slip severity were taken from large retrospective series. All meaningful clinical scenarios with regard to long-term outcome for the hip were considered in the model. Variables of uncertainty were subjected to sensitivity analyses in order to explore the effect on outcome over the range of plausible values for variables of interest. RESULTS: The results showed a benefit in the long-term outcome for patients who had prophylactic pinning of the contralateral hip. The threshold level at which a benefit is obtained with prophylactic pinning is expressed according to the rates of sequential slip, rates of slips overlooked at follow-up, and complications associated with prophylactic pinning of the contralateral hip. CONCLUSIONS: The decision model shows that, when pooled data are used to predict probabilities of sequential slip, treatment of the contralateral hip with prophylactic pinning is beneficial to the long-term outcome for that hip. When considering prophylactic pinning of the contralateral hip, the clinician should use sound clinical judgment with respect to the age, sex, and endocrine status of the patient. Long-term follow-up studies are needed to establish the efficacy of prophylactic pinning, but the predictions in the present study, which are based on findings in the literature, support the safety of this procedure.     

Chondroblastoma with secondary aneurysmal bone cyst of the hamate: case report

Chondroblastoma of the carpals is rare, can mimic other benign bone tumors, and presents a diagnostic challenge. There have been few cases of benign tumors involving the hamate, with only one reported case of chondroblastoma, which was treated with complete hamate excision. We present a case of chondroblastoma with secondary aneurysmal bone cyst of the hamate treated with curettage, high-speed burring, phenol, and autogenous iliac crest bone grafting. At the time of the most recent radiographic follow-up, there was full graft incorporation, preserved hamate morphology, and no evidence of recurrence.