An analysis of hip dislocations among snowboarders and skiers: a 10-year prospective study from 1992 to 2002

BACKGROUND: We evaluated the types and mechanisms of hip dislocation sustained while snowboarding and skiing, a subject about which there have been few studies. METHODS: In a prospective cohort study between 1992 and 2002, we studied 30 snowboarders and 8 skiers with hip dislocations. RESULTS: The incidence of dislocation with or without fracture of the hip joint in snowboarders was five times higher than in skiers (0.45 per 100,000 visits for snowboarders vs. 0.09 for skiers). The most remarkable differences between skiing and snowboarding hip injuries were that in the former there was a significantly higher incidence of anterior hip dislocation (p < 0.05) and in the latter there was a significantly higher incidence of posterior hip dislocation (p < 0.05). Furthermore, the rate of type V hip dislocation (with fracture of the femoral head) was higher in snowboarders (9 of 30 cases [30.0%]) than in skiers (1 of 8 cases [12.5%]). CONCLUSION: Hip dislocations are much more common in snowboarders than in skiers. Furthermore, the causes and types of hip dislocation differ between snowboarding and skiing.     

全髋关节置换术后脱位危险因素分析及防治措施

目的探讨人工髋关节置换术后脱位易发因素及其防治措施。方法回顾分析1998年1月～2002年12月来所进行的人工髋关节置换术共141例(151侧),年龄22～86岁,男66例,女75例,因股骨头坏死致手术64例,因股骨头/颈骨折者47例,其他30例,均采用后外侧切口。结果其中发生关节脱位7例(男3例,女4例),发生率2%。初次脱位时间于术后4天至半年不等。单次脱位5例,多次脱位2例,均为后脱位。保守治疗6例(10次),闭合手法复位成功;手术治疗2例(2次),1例术后1周发现脱位需手术切开复位并调整臼杯位置,1例手术松解软组织方可复位。结论手术避免假体安放不当及软组织失衡,术后正确护理可降低脱位的发生。     

髋臼骨折、髋关节脱位合并坐骨神经损伤的临床分析

目的探讨髋臼骨折、髋关节脱位合并坐骨神经损伤的临床特点及发病机制。方法回顾髋臼骨折、髋关节脱位及髋臼骨折合并髋关节脱位的患者155例(159侧),其中合并坐骨神经损伤35侧。分析髋臼骨折、髋关节脱位的流行病学特点及坐骨神经损伤与髋臼骨折、髋关节脱位分型的关系。结果81.3%的患者为男性,86.5%的患者年龄为20～50岁,83.9%为车祸伤所致。坐骨神经损伤总发病率为22.01%,而在髋臼骨折为17.19%,在单纯髋关节后脱位为12.90%,在髋臼骨折合并髋关节后脱位为36.36%。31侧坐骨神经损伤中48.39%为腓总神经成分损伤,51.61%为腓总神经 胫神经损伤。结论车祸伤是髋臼骨折、髋关节脱位的主要原因,多见于成年男性。坐骨神经损伤主要发生于髋臼后壁、后柱骨折合并髋关节后脱位患者,且腓总神经成分损伤多见。     

Inferior dislocation of the hip: a case series and literature review

Inferior hip dislocation is the rarest type among all hip dislocations.Very few cases have been reported in the English literature.Most of the earlier reported cases involves the pediatric age group.No...     

Temporary cement tectoplasty: a technique to improve prefabricated hip spacer stability in two-stage surgery for infected hip arthroplasty

This technical note describes an intraoperatively custom-made, antibiotic-loaded bone cement roof, used in conjunction with a prefabricated hip spacer to improve component stability, as part of the first stage of a two-stage procedure for an infected hip implant. This technique was successfully used in seven cases who presented with extensive superior and/or posterio-superior acetabular defect, which created a risk of spacer dislocation. With this technique we were able to avoid any further dislocation in these seven cases. We believe that the technique may reduce postoperative spacer dislocation in cases with extensive acetabular defects, while improving clinical outcomes.     

Simultaneous anterior and posterior dislocation of hips:a case report and review of literature

The presence of anterior hip dislocation along with contralateral posterior hip dislocation in the absence of other major traumas is a distinctly rare injury pattern.We report such a case,along with a ...     

Late developmental dislocation of the hip after initial normal evaluation: a report of five cases

Developmental dysplasia of the hip (DDH) denotes a wide spectrum of pathologies ranging from hip instability to frank dislocation. The current understanding is that cases of late diagnosis were missed during the newborn period. However, there is some evidence that a number of hip subluxations or dislocations may have been clinically stable in the neonatal period, but dislocate late. We present 5 cases of otherwise healthy children with normal physical examinations and hip radiographs in the first 3 months of life who later developed hip dislocations. Four of the 5 cases required surgical open reduction. In light of these cases and others in the literature, normal neonatal screening for DDH does not assure that continued normal development of the hip joint will happen. Our study confirms the existence of another entity in the wide spectrum of DDH: the late hip dislocation. Therefore, hip evaluations should be continued beyond the neonatal period until the child begins to walk. Parents should be informed that hip dislocation can occur in a late form, and they should be encouraged to take their children for repeated evaluations even if the neonatal screening is normal.     

Use of a constrained tripolar acetabular liner to treat intraoperative instability and postoperative dislocation after total hip arthroplasty: a review of our experience

Constrained acetabular components have been used to treat certain cases of intraoperative instability and postoperative dislocation after total hip arthroplasty. We report our experience with a tripolar constrained component used in these situations since 1988. The outcomes of the cases where this component was used were analyzed for component failure, component loosening, and osteolysis. At average 10-year followup, for cases treated for intraoperative instability (2 cases) or postoperative dislocation (4 cases), the component failure rate was 6% (6 of 101 hips in 5 patients). For cases where the constrained liner was cemented into a fixed cementless acetabular shell, the failure rate was 7% (2 of 31 hips in 2 patients) at 3.9-year average followup. Use of a constrained liner was not associated with an increased osteolysis or aseptic loosening rate. This tripolar constrained acetabular liner provided total hip arthroplasty construct stability in most cases in which it was used for intraoperative instability or postoperative dislocation.     

Traumatic hip dislocation in the paediatric population: A case series from a specialist centre

IntroductionTraumatic hip dislocation is a rare injury in the paediatric population. It can occur after high energy trauma, but also after lower energy injuries especially in younger children. Posterior dislocation is the most common pattern of hip dislocation. In most cases, closed reduction is successful, but occasionally open reduction is required to achieve concentric reduction. The aim of our study was to present the 10-year experience from a Level-1 Trauma Paediatric Hospital and to comment on how our experience correlates with the current literature.Patients and methodsThis is a retrospective case series of all paediatric patients (< 16 years old) with a traumatic hip dislocation presented and/or treated at our institution, between the 1^st of January 2010 and 31^st August 2020.ResultsThirteen cases of traumatic hip dislocation were identified. There were 7 females. The mean age was 9.8 years. Typically, younger patients were involved in lower energy injuries. The direction of hip dislocation was posterior in ten cases. Associated injuries were seen in eight patients. All cases underwent closed reduction, which was successful in nine cases. Mean time to reduction was 6.8 hours. Post reduction imaging with CT and/or MRI was performed in all cases. There was residual subluxation in three cases, requiring open reduction. In one case with unrecognised undisplaced physeal injury, closed reduction resulted in a Delbet type 1 hip fracture. Two cases developed avascular necrosis (AVN).ConclusionsTraumatic paediatric hip dislocation is a rare injury. A target of 6 hours for reduction should be employed as this will reduce the risk of AVN in those who have not permanently damaged the vessels at the time of injury. We advocate all attempts for closed reduction to be performed in an operating theatre with the use of an image intensifier to help identifying associated injuries and confirm concentric reduction. If closed reduction fails, open reduction is required. Post-reduction MRI is an important adjunct to recognise associated soft tissue injuries. Follow up of patients should continue for 2 years as a minimum to help detect AVN.     

Traumatic anterior dislocation of the hip joint with posterior acetabular wall fracture

The incidence of traumatic hip dislocation has increased in recent years as a result of high-energy trauma. Anterior hip dislocation forms less than 10-15% of all traumatic hip dislocations. Only a few case reports describe anterior dislocation along with acetabular fractures. The acetabular fracture involved the anterior wall or column in all such cases. We describe a rare case in which anterior superior dislocation of the hip was associated with a large fracture fragment of theposterior acetabular rim and adjacent wall.     

Delayed presentation of post-traumatic posterior dislocation of the hip with acetabular rim fracture

Two cases of posterior dislocation of the hip occurring some time after injury are described. Each had an associated acetabular rim fracture which was missed at the initial examination because there was no clinical indication to X-ray the hip. We have been unable to discover previous recording of traumatic posterior dislocation of the hip occurring in this manner.     

Bilateral inferior dislocation of the hip---a case report

Inferior dislocation of the hip is the rarest type in hip dislocation.Very few cases have been reported in the anglophonic literature,most of which involved the pediatric age group.Surprisingly,we came...     

Traumatic hip dislocation with spontaneous incomplete reduction: a diagnostic trap

We are reporting three children and adolescents who presented with incongruous reduction of the hip following injury. In each case, the diagnosis was initially missed. None of the patients presented with a hip dislocation, but two gave a history consistent with transient hip subluxation or dislocation. Low-energy trauma was the cause in two cases. Treatment consisted of arthrotomy to remove interposed capsule and labrum to obtain concentric reduction. When reduction of a hip dislocation occurs spontaneously, the condition may be misjudged. Any child or adolescent who complains of hip pain following injury should have radiographs scrutinized for asymmetric widening of the hip joints. Any asymmetry should be evaluated by appropriate imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI). Removal of any interposed tissue is recommended, even when the diagnosis is delayed by several months.     

骨盆Salter截骨治疗发育性髋关节脱位术后渐发脱位的原因分析

目的 探讨骨盆Salter截骨治疗发育性髋关节脱位术后渐发脱位的原因.方法 采用骨盆Salter截骨治疗63例儿童发育性髋关节脱位.7例术后发生渐发脱位,分析其发生原因.结果 患儿均获得随访,时间12～89个月.术后发生渐发脱位7例中,3例因术后关节囊松弛,不能有效维持关节稳定性,通过佩带髋外展支具后髋关节恢复稳定;2...     

Prevention of dislocation after hip arthroplasty: lessons from long-term followup.

Regarding dislocation after total hip arthroplasty, prevention is worth an ounce of cure. The current authors evaluated dislocation after total hip arthroplasty during the 26-year practice of one surgeon to identify potential variables that can contribute to the prevention of dislocation. Between 1970 and 1996, dislocation after total hip replacement occurred after 7.2% of primary hip arthroplasty procedures (298 of 4164 primary hip replacements) and 11.2% of revision hip arthroplasty procedures (90 of 803 revision hip replacements). Significant findings included an increase in dislocation when 22-mm modular femoral heads were used and a decrease in dislocation after revision for dislocation when constrained liners were used. An additional finding was that 26% of first time dislocations occurred more than 2 years after surgery. Concerning prevention of dislocation, small head modular femoral components should be used cautiously, and constrained liners should be considered in complex revision cases. Patients should be counseled concerning the potential for dislocation many years after their arthroplasty.     

X线、CT和3D-CT对外伤性髋关节脱位的诊断价值

目的　分析外伤性髋关节脱位诊治中存在的问题并提出相应的对策。方法　回顾性分析 37例外伤性髋关节脱位的临床资料 ,并予以统计学处理。结果　 10例合并的髋部骨折、13例关节内碎骨片被X线片漏诊 ;中心型髋关节脱位及水平位髋臼骨折各 1例被常规CT遗漏 ;髋臼裂缝骨折及髋关节内碎骨片各 2例被三维CT漏诊 ;三维CT误诊关节内碎骨片 2例 ;且采用不同的影像学诊断方法 ,治疗效果明显不同。结论　不管任何类型的外伤性髋关节脱位在行X线片检查得到初步诊断后均应即刻手法复位 ,之后在行X线片复查的基础上 ,必须进行二维CT(有条件者包括三维CT)检查 ,以确定髋关节脱位、髋部骨折复位程度或确定是否并发骨折及分型 ,以指导制定进一步治疗方案     

Bioball universal modular neck adapter as a salvage for failed revision total hip arthroplasty

Management of recurrent dislocation of total hip arthroplasty is often a challenging and daunting task. Re-revision of such a total hip prosthesis may not be easy as the removal of a well-fixed, fully coated stem is extremely difficult. We managed to salvage instability in three revision hip cases in which the fully coated stem had subsided by using a bioball universal neck adapter without changing the femoral stem or acetabular cup.     

Recurrent traumatic hip dislocation in a child

Recurrent traumatic hip dislocation is rarely seen in childhood. We presented a case of traumatic hip dislocation which was treated by conservative methods. A two-year-old girl was treated with closed reduction and a hip spica cast for posterior traumatic dislocation in the right hip. Two years later, a recurrent dislocation occurred following a minor trauma on the same side. She was again treated with closed reduction and immobilization with a hip spica cast for three weeks followed by a three-week load bearing restriction. Early follow-up examinations showed an increased internal rotation of the hip compared to the left side, suggesting increased posterior capsular laxity. It then disappeared on her final follow-up at age six and magnetic resonance imaging showed no evidence for avascular necrosis or capsular laxity. She was asymptomatic and her physical examination was within normal limits. Of note, several members in her family had developmental dysplasia of the hip.     

Pathological dislocation of the hip in neurofibromatosis: a case report

The Authors report the case of a 28-year-old patient with type 1 neurofibromatosis, who presented a pathological dislocation of the hip. This event was preceded by the development of a neurological pattern of spastic paraparesis and decreased pain sensation in both lower limbs, secondary to the progression of a dystrophic kyphoscoliosis. Pathological dislocation of the hip in neurofibromatosis has been reported in the literature as a consequence of intra-articular growth of neurofibromas. Conversely, in the case described here, clinical and radiographic features and the absence of neurofibromas in the joint, verified by means of radiographic and histological examinations, suggested the diagnosis of neuropathic arthropathy. The treatment of hip dislocation should be differentiated according to the aetiology, given the underlying articular instability in cases of neuropathic arthropathy.     

Obturator dislocation as a complication of closed reduction of the congenitally dislocated hip: a report of two cases

Two cases of inferior obturator dislocation complicating treatment of congenital hip dislocation with closed reduction are described. Abduction and hyperflexion appear to be predisposing factors in development of this complication. Application of skin traction before any attempt is made at reduction will lengthen contracted soft tissues and may convert the inferior dislocation to a more manageable position. Open reduction was necessary in both patients, and the results were considered good.