BACKGROUND Developmental dysplasia of the hip is a developmental abnormality of the hip joint that results from hypoplasia during birth and continues to deteriorate after birth.AIM To observe the effects of magnesium ...BACKGROUND Developmental dysplasia of the hip is a developmental abnormality of the hip joint that results from hypoplasia during birth and continues to deteriorate after birth.AIM To observe the effects of magnesium sulfate wet compress,iodophor wet compress,and ice compress on reducing postoperative perineal swelling in children with developmental hip dislocation to provide effective nursing interventions in the clinic.METHODS A total of 120 children with hip dislocation after surgery in a third-class A hospital from January 2018 to January 2020 were randomly divided into four groups,the magnesium sulfate wet compress group,iodophor wet compress group,ice compress group and the control group.Data such as height,weight,age,duration of surgery,intraoperative blood loss,postoperative body temperature,swelling duration,pain score,and incidence of blisters were collected and analyzed.RESULTS There were no significant differences in height,weight,age,duration of surgery,intraoperative blood loss,and postoperative body temperature among the four groups of children.Statistical differences were observed between the intervention groups and the control group(P<0.05).CONCLUSION All three methods significantly reduced postoperative perineal swelling in children with developmental hip dislocation,reduced the duration of postoperative perineal swelling,reduced pain,and improved the quality of care.展开更多
BACKGROUND Femoral head fractures(FHFs)are considered relatively uncommon injuries;however,open reduction and internal fixation is preferred for most displaced fractures.Several surgical approaches had been utilized w...BACKGROUND Femoral head fractures(FHFs)are considered relatively uncommon injuries;however,open reduction and internal fixation is preferred for most displaced fractures.Several surgical approaches had been utilized with controversial results;surgical hip dislocation(SHD)is among these approaches,with the reputation of being demanding and leading to higher complication rates.AIM To determine the efficacy and safety of SHD in managing FHFs by reviewing the results reported in the literature.METHODS Major databases including PubMed,Embase,Web of Science,and Cochrane Central Register of Controlled Trials were searched to identify studies reporting on outcomes of SHD utilized as an approach in treating FHFs.We extracted basic studies data,surgery-related data,functional outcomes,radiological outcomes,and postoperative complications.We calculated the mean differences for continuous data with 95%confidence intervals for each outcome and the odds ratio with 95%confidence intervals for binary outcomes.P<0.05 was considered significant.RESULTS Our search retrieved nine studies meeting our inclusion criteria,with a total of 129 FHFs.The results of our analysis revealed that the average operation time was 123.74 min,while the average blood loss was 491.89 mL.After an average followup of 38.4 mo,a satisfactory clinical outcome was achieved in 85%of patients,ranged from 30%to 86%,with avascular necrosis,heterotopic ossification,and osteoarthritis being the most common complications occurring at an incidence of 12%,25%,and 16%,respectively.Trochanteric flip osteotomy nonunion and trochanteric bursitis as a unique complication of SHD occurred at an incidence of 3.4%and 3.8%,respectively.CONCLUSION The integration of SHD approach for dealing with FHFs offered acceptable functional and radiological outcomes with a wide range of safety in regards to the hip joint vascularity and the development of avascular necrosis,the formation of heterotopic ossification,and the development of posttraumatic osteoarthritis;however,it still carries its unique risk of trochanteric flip osteotomy nonunion and persistent lateral thigh pain.展开更多
BACKGROUND Femoroacetabular impingement(FAI)is a predisposing factor for secondary osteoarthritis of the hip joint.The two extensively described impingement mechanisms of FAI are CAM and Pincer-type.Initially managed ...BACKGROUND Femoroacetabular impingement(FAI)is a predisposing factor for secondary osteoarthritis of the hip joint.The two extensively described impingement mechanisms of FAI are CAM and Pincer-type.Initially managed conservatively,operative intervention should be offered to the persistently symptomatic patient.The measurement of the alpha angle is considered a standard method of assessing the severity of pathology in Cam-type FAI on pre-operative plain radiographs.The radiological correction of the alpha angle has not been previously compared between different surgical approaches.We hypothesize that there is no difference in alpha angle correction between Ganz surgical hip dislocation and the anterior mini-open approach.AIM To compare the magnitude of alpha angle correction achieved by using the Ganz surgical hip dislocation and the anterior mini-open approach.METHODS This is a retrospective study assessing seventy-nine patients identified in a 5-year period.These patients had preoperative radiographic evidence of FAI and underwent surgery by a single surgeon at our institution,a tertiary care center.Patients with missing radiographic documentation,radiographs with insufficient quality which then precluded accurate measurement of the angleα,a diagnosed congenital condition,isolated type II pathology(Pincer),and history of prior surgery were excluded from the study.Either the Ganz surgical hip dislocation or the anterior mini open approach was used.Postoperative radiographic evaluation of the alpha angle between the two surgical methods was done and corrected for age and gender using two-sample t-tests and Chi-square analyses.RESULTS A total of 79 patients met the inclusion and exclusion criteria.Forty-seven males(mean age of 35.3,range 16-53)and 32 females(mean age 36.7,range 16-60)were enrolled.Forty-seven patients underwent the anterior mini-open approach,and 32 underwent the Ganz surgical hip dislocation.There were no significant differences in age between the two surgical groups or in pre-and post-operative alpha angles based on patient gender.The mean pre-operative alpha angle for the Ganz surgical hip dislocation group was 88.0 degrees(SD 12.3)and 99.4 degrees(SD 7.2)for the anterior mini-open group.Mean post-operative angles were 49.9 degrees(SD 4.3)for the Ganz surgical hip dislocation and 43.8(SD 4.3)degrees for the anterior mini-open group.There was a statistically significant difference in patient’s pre-operative and post-operative angles(P=0.000)with both surgical approaches.CONCLUSION Statistically significant decreases in alpha angle were noted for both surgical techniques,with larger decreases seen in the anterior mini-open group.展开更多
BACKGROUND:Traumatic bilateral hip dislocation is a rare condition.Anterior shoulder dislocation combined with this condition is even a rare occurrence.A 57-year-old man had bilateral asymmetric hip dislocation with a...BACKGROUND:Traumatic bilateral hip dislocation is a rare condition.Anterior shoulder dislocation combined with this condition is even a rare occurrence.A 57-year-old man had bilateral asymmetric hip dislocation with a posterior wall fracture of the left acetabulum associated with right shoulder anterior dislocation caused by falling down from a cherry tree.Traumatic hip dislocation and anterior shoulder dislocation represent a true orthopedic emergency.METHODS:Closed reduction was performed immediately for three of the dislocated joints.Posterior wall fracture of the left acetabulum was treated with open reduction and internal fixation by screws.Because of the severity of associated complications like aseptic necrosis or posttraumatic osteoarthritis,efforts were made to ensure prompt diagnosis,therapy and prognosis.RESULTS:The patient was successfully treated by open reduction and internal fixation of the left acetabulum,and discharged from the hospital.CONCLUSION:Traumatic asymmetric hip dislocation and anterior shoulder dislocation are an orthopedic emergency and early diagnosis with immediate reduction of the dislocation is the key determinants of excellent result of treatment.展开更多
BACKGROUND Traumatic hip dislocation usually occurs following high-velocity trauma.It is imperative that the dislocation be reduced in a timely manner,especially in a closed manner,as an orthopedic emergency.However,c...BACKGROUND Traumatic hip dislocation usually occurs following high-velocity trauma.It is imperative that the dislocation be reduced in a timely manner,especially in a closed manner,as an orthopedic emergency.However,closed reduction can hardly be achieved in patients who also have ipsilateral lower extremity fractures.Herein,we focus on hip dislocation associated with ipsilateral lower extremity fractures,excluding intracapsular fractures(femoral head and neck fractures),present an early closed hip joint reduction method for this injury pattern,and review the literature to discuss the appropriate closed reduction technique for this rare injury pattern.CASE SUMMARY We report a case of a 37-year-old male who sustained a left acetabular posterior wall fracture,an ipsilateral comminuted subtrochanteric fracture and dislocation of the hip.The hip dislocation was reduced urgently in a closed manner using the joy-stick technique with a T-shaped Schanz screw.The fractures were reduced and fixed as a 2nd-stage surgery procedure.At the 17-month postoperative follow-up,the patient had full range of motion of the affected hip.CONCLUSION Closed reduction of a hip dislocation associated with ipsilateral lower extremity fractures is rarely achieved by regular maneuvers.Attempts at closed reduction,by means of indirectly controlling the proximal fracture fragment or reconstructing the femoral leverage rapidly with the aid of various external reduction apparatuses,were shown to be effective in some scenarios.Mandatory open reduction is indicated in cases of failed closed reduction,particularly in irreducible dislocations.展开更多
Introduction: Observing and treatment of hip dysplasia in children have always been in the sphere of interest of modern molecular medicine. The role of molecular factors in the formation of connective tissue dysplasia...Introduction: Observing and treatment of hip dysplasia in children have always been in the sphere of interest of modern molecular medicine. The role of molecular factors in the formation of connective tissue dysplasia in children is considered crucial for such multisystem disorders, and connective tissue dysplasia progressing involves immune system parameters and biochemical markers. The aim of this work was to establish the relationship between immune status indicators and biochemical markers of connective tissue using bioinformatics and modeling methods. Materials and Methods: 27 patients with congenital hip dislocation, admitted to the University Clinic of Privolzhsky Research Medical University, Department of children orthopedics for surgical treatment, were examined. Determination of 10 blood parameters was conducted by modern biochemical and immunological methods. Statistica 12.0 software from StatSoft was used for statistical data processing. Methods of nonparametric statistics were used since the samples in the control group partially follow the normal distribution. Correlation methods and regression modeling methods were used to evaluate the relationship of indicators. Results and Conclusion: In our investigation we have shown the presence of statistical and mathematical interactions between the parameters of innate immunity and indicators of connective tissue metabolism. The leading role of the immune system in the development of pathologies associated with connective tissue dysplasia is assumed. In further investigations it is necessary to clarify the role hypoxia in HIF-1 stimulated control of skeletal dysplasia, collagen modification, connective tissue dysplasia development.展开更多
Posterior hip dislocation with greater trochanter fracture is an uncommon injury pattern in the acute trauma patient. Frequently associated injury includes a combination of hip dislocation with posterior wall of aceta...Posterior hip dislocation with greater trochanter fracture is an uncommon injury pattern in the acute trauma patient. Frequently associated injury includes a combination of hip dislocation with posterior wall of acetabulum, head of femur fracture, intertrochanteric fracture and even the most severe type of combined acetabular fracture. We report a 42-year-old man post traumatic bilateral hip injuries with irreducible posterior hip dislocation and associated isolated greater trochanteric fracture successfully managed with open reduction and fixation of greater trochanter with universal locking trochanteric stabilization plate.展开更多
Objective: to explore the effect of early rehabilitation nursing intervention on the prognosis of children with developmental hip dislocation. Methods: 82 cases of pediatric developmental hip dislocation from May 2018...Objective: to explore the effect of early rehabilitation nursing intervention on the prognosis of children with developmental hip dislocation. Methods: 82 cases of pediatric developmental hip dislocation from May 2018 to September 2020 in our department were taken as the observation objects, and divided into the rehabilitation group and the basic group, using early rehabilitation nursing and using basic nursing respectively. Results: in comparison of FMA and VAS scores after nursing between the rehabilitation group and the basic group, those in the rehabilitation group were 27.58±3.77 (points) and 2.01±0.22 (points), respectively, and those in the basic group were 19.85±2.89 (points) and 3.87±0.52 (points), respectively (t = 9.852, P =0.000). The results were different. Conclusion: the effect of early rehabilitation nursing after the operation of children with developmental dislocation of hip joint is good and the method can be popularized.展开更多
BACKGROUND Developmental dysplasia of the hip(DDH)remains a significant public health challenge,particularly in developing countries where cultural factors and limited access to appropriate medical equipment complicat...BACKGROUND Developmental dysplasia of the hip(DDH)remains a significant public health challenge,particularly in developing countries where cultural factors and limited access to appropriate medical equipment complicate optimal management.AIM To evaluate the difficulties encountered in the management of DDH in our healthcare setting.METHODS A retrospective,single-center study was conducted over nine years(2015-2023),including 20 patients(26 hips)with idiopathic DDH.Patients with post-traumatic or post-infectious hip dislocations were excluded.Data collected included age at diagnosis,laterality,Tönnis classification,duration of traction,and surgical interventions.RESULTS The mean age at diagnosis was 35.6 months(4 months to 10.8 years).Dislocation was unilateral in 70%of cases;69.2%were classified as Tönnis stage 3 or 4.The average traction duration was 57.5 days.Surgery was performed in 8 hips.Among 16 patients with regular follow-up,10 showed good outcomes,3 excellent,and 3 fair according to the McKay score.Older age at treatment(>1 year),bilateral dislocation,and higher severity(Tönnis stages 3 and 4)were associated with worse functional outcomes.No significant correlation was found between functional and radiological results.Residual dysplasia occurred in 3 patients,and 1 re-dislocation was noted.CONCLUSION Delayed diagnosis and advanced severity at presentation are key challenges in managing DDH in our context.Nevertheless,appropriate management can achieve generally favorable outcomes,despite complications linked to prolonged treatment and resource limitations.展开更多
Bilateral hip dislocation rarely occurs. In this paper, a case of bilateral hip dislocation associated with bilateral sciatic nerve palsy resulted from a road traffic accident is reported. Both hips were emergently re...Bilateral hip dislocation rarely occurs. In this paper, a case of bilateral hip dislocation associated with bilateral sciatic nerve palsy resulted from a road traffic accident is reported. Both hips were emergently reduced under general anaesthesia. Acetabular reconstruction was done bilaterally due to the unstable hips. The patient subsequently developed heterotopic ossification and avascular necrosis on the left hip and underwent total hip arthroplasty. The sciatic nerve on the right side achieved complete recovery but that on the left side only partly recovered and was augmented by tendon transfer. Such injuries are serious and one should be aware of the complications because they can resurface and so patients should be followed up for a long time. To the best of our knowledge, this kind of injury has not been reported in the English .language literature.展开更多
Femoral head fractures without disloca- tion or subluxation are extremely rare injuries. We report a neglected case of isolated comminuted fracture of femoral head without hip dislocation or subluxation of one year du...Femoral head fractures without disloca- tion or subluxation are extremely rare injuries. We report a neglected case of isolated comminuted fracture of femoral head without hip dislocation or subluxation of one year duration in a 36-year-old patient who sustained a high en- ergy trauma due to road traffic accident. He presented with painful right hip and inability to bear full weight on right lower limb with Harris hip score of 39. He received cementless total hip replacement. At latest follow-up of 2.3 years, functional outcome was excellent with Harris hip score of 95. Such isolated injuries have been described only once in the literature and have not been classified till now. The purpose of this report is to highlight the extreme rarity, pos- sible mechanism involved and a novel classification system to classify such injuries.展开更多
Traumatic posterior hip dislocation is an uncommon injury in children, constituting less than 5% of paediatric dislocations. In a younger child （〈5 years）, minor trauma such as a slip or fall from a low height may ...Traumatic posterior hip dislocation is an uncommon injury in children, constituting less than 5% of paediatric dislocations. In a younger child （〈5 years）, minor trauma such as a slip or fall from a low height may cause a hip dislocation, whereas in an adolescent a dislocation is usually caused by a major trauma such as motor vehicle accident. In this case report we present a rare case of trau- matic hip dislocation in a 16-month-old girl. Early detectionand closed reduction ensured good outcome in our case. A high index of suspicion is necessary to achieve satisfactory reduction within six hours of dislocation because reduction after this period will greatly increase the risk of complications.展开更多
The authors reported the case of a 27- year-old man who sustained an irreducible postero-lateral traumatic dislocation of the hip with capsular and labral entrapment. Initial X-rays showed only a small acetabular frag...The authors reported the case of a 27- year-old man who sustained an irreducible postero-lateral traumatic dislocation of the hip with capsular and labral entrapment. Initial X-rays showed only a small acetabular fragment. After two attempts to reduce the hip with muscle paralysis under general anaesthesia failed, the patient was treated by immediate open reduction through a posterolateral approach. Surgical exploration of the hip revealed a small osteochondral fragment attached to a large piece of labrum and capsule, clogging the acetabulum. The femoralhead crossed over the torn capsule with a buttonhole effect. These elements were relieved, the bone fragment was fixed with a 2 mm screw and the capsule was repaired. At the 10- year follow-up, the functional outcome was excellent with a Harris score of 100 points and no signs of necrosis or osteoarthritis. The authors propose a literature review of this uncommon lesion.展开更多
Obturator dislocation is a rare type of hip dislocation,accounting for about 2%-5%of all hip dislocations.The occurrence of old unreduced obturator dislocation is even more infrequent,with only 17 cases reported in ni...Obturator dislocation is a rare type of hip dislocation,accounting for about 2%-5%of all hip dislocations.The occurrence of old unreduced obturator dislocation is even more infrequent,with only 17 cases reported in nine studies,most of which were from the 1950s to 1980s in developing countries.CASE SUMMARY A 38-year-old woman from Hunan Province,China presented with stiffness of the left hip in abduction,flexion,and external rotation after falling from a 2-meter-tall tree onto her left knee 1.5 mo prior.Pelvic radiograph and computed tomography revealed obturator dislocation of the left hip accompanied by impaction fracture at the superolateral aspect of the left femoral head without associated acetabulum fracture.Open reduction was performed,resulting in restoration of the concentric alignment of the left hip.After surgery,6-wk skin traction was applied and the patient was kept in bed for an additional 2 wk.At 3 mo after surgery,the patient reported experiencing some pain,which did not affect the function of the affected limb,and some movement restriction but no abduction deformity or claudication was present.An X-ray showed that the left hip was homocentric,and there was no sign of posttraumatic arthritis or avascular necrosis.CONCLUSION Open reduction may be an effective treatment strategy for the rare condition of old unreduced obturator dislocation with short neglect time.展开更多
Traumatic hip dislocations occur in children below 15 years old. Just as in adults, posterior hip dislocations are 10 times more common than anterior hip dislocations. Traumatic hip dislocation in pediatric
Objective To explore the causes and management of prosthesis disocation after artificaial hip replacement (AHR).Methods Seventeen patients with prosthesis dislocation after AHR during January 2000 to July 2010 were st...Objective To explore the causes and management of prosthesis disocation after artificaial hip replacement (AHR).Methods Seventeen patients with prosthesis dislocation after AHR during January 2000 to July 2010 were studied展开更多
This paper discussed the injury mechanism and management of a patient who had concomitant ipsilateral hip and knee dislocations and contralateral open leg fracture. A 32-year-old man presented with ipsilateral fractu...This paper discussed the injury mechanism and management of a patient who had concomitant ipsilateral hip and knee dislocations and contralateral open leg fracture. A 32-year-old man presented with ipsilateral fracturedislocations of the left hip （Pipkin＇s type IV） and knee （Moore II）joints and contralateral open fracture of the leg bones after a car accident. After emergency resuscitative measures, the hip joint was reduced and Pipkin＇s fracture was fixed using Ganz approach with lag screws; knee joint was reduced closely and tibial plateau fracture was stabilized with lateral buttress plate and a transarticular spanning fixator. The open fracture on the other leg was debrided and fixed with an external fixator. There was no insta-bility in both joints after fixation when he was examined under anesthesia. The fractures united after 3 months and the patient had no residual instability of hip and knee. There was no clinical or radiological evidence of osteonecrosis in the hip joint after 6 months. At one-year follow-up, he had satisfactory functional outcome with almost normal range of motion at both joints. Ipsilateral hip and knee dislocations are rare injuries and more caution is needed for early diagnosis. A timely appropriate intervention can provide good functional outcome to the patient in this situation.展开更多
Traumatic posterior dislocation of hip associated with ipsilateral displaced femoral neck fracture is a rare injury. Moreover, the management of such patients evokes strong views regarding primary replacement or prese...Traumatic posterior dislocation of hip associated with ipsilateral displaced femoral neck fracture is a rare injury. Moreover, the management of such patients evokes strong views regarding primary replacement or preserving the femoral head. We presented a case of young adult with such an injury. He was operated upon with reduction of the dislocation and fixation of femoral neck fracture with the help of cancellous screws. Two years later, the fracture had united and the patient was asymptomatic. We further proposed the mechanism of injury for such a fracture and discussed the management in the changing trauma scenario of the developing world.展开更多
Inferior hip dislocation is the rarest type among all hip dislocations. Very few cases have been re ported in the English literature. Most of the earlier reported cases involves the pediatric age group. No single case...Inferior hip dislocation is the rarest type among all hip dislocations. Very few cases have been re ported in the English literature. Most of the earlier reported cases involves the pediatric age group. No single case series could be found in the English literature. We came across 4 cases of inferior hip dislocation with a varied age profile （range 10 to 56 years, mean 33.8 years）. Patients with this disease usually complained of pain and kept the thigh flexed and abducted. The diagnosis can be confirmed by radiographs which reveal that the long axis of the femur varies in alignment with respect to the spine from parallel toan angle almost 90° away from the axis. In our series, closed reduction was successful in all patients, either under seda tion or general anaesthesia. Skin traction for a period of 6 weeks was applied in all of them and followup revealed painfree, stable and mobile hips. In this study we present the details of these cases along with a review of literature discussing the various modes and mechanisms that pro duce inferior hip dislocation.展开更多
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 across a 30...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 across a 30- year-old patient with a bilateral inferior hip dislocation. He had sustained a road traffic accident and the attitude of both hip joints was flexion and abduction. The diagnosis was confirmed by radiographs which revealed the long axis of the femur at an angle of 1 l0 （right） degrees and 100 （left）degrees respectively away from the axis. Closed reduction under sedation was successfully performed. Skin traction for a period of 6 weeks was advised and the follow-up revealed an excellent result. We present the details of this case, the first of its kind along with a review of the literature, discussing the various modes and mechanisms of injury inducing inferior dislocation of the hip.展开更多
文摘BACKGROUND Developmental dysplasia of the hip is a developmental abnormality of the hip joint that results from hypoplasia during birth and continues to deteriorate after birth.AIM To observe the effects of magnesium sulfate wet compress,iodophor wet compress,and ice compress on reducing postoperative perineal swelling in children with developmental hip dislocation to provide effective nursing interventions in the clinic.METHODS A total of 120 children with hip dislocation after surgery in a third-class A hospital from January 2018 to January 2020 were randomly divided into four groups,the magnesium sulfate wet compress group,iodophor wet compress group,ice compress group and the control group.Data such as height,weight,age,duration of surgery,intraoperative blood loss,postoperative body temperature,swelling duration,pain score,and incidence of blisters were collected and analyzed.RESULTS There were no significant differences in height,weight,age,duration of surgery,intraoperative blood loss,and postoperative body temperature among the four groups of children.Statistical differences were observed between the intervention groups and the control group(P<0.05).CONCLUSION All three methods significantly reduced postoperative perineal swelling in children with developmental hip dislocation,reduced the duration of postoperative perineal swelling,reduced pain,and improved the quality of care.
文摘BACKGROUND Femoral head fractures(FHFs)are considered relatively uncommon injuries;however,open reduction and internal fixation is preferred for most displaced fractures.Several surgical approaches had been utilized with controversial results;surgical hip dislocation(SHD)is among these approaches,with the reputation of being demanding and leading to higher complication rates.AIM To determine the efficacy and safety of SHD in managing FHFs by reviewing the results reported in the literature.METHODS Major databases including PubMed,Embase,Web of Science,and Cochrane Central Register of Controlled Trials were searched to identify studies reporting on outcomes of SHD utilized as an approach in treating FHFs.We extracted basic studies data,surgery-related data,functional outcomes,radiological outcomes,and postoperative complications.We calculated the mean differences for continuous data with 95%confidence intervals for each outcome and the odds ratio with 95%confidence intervals for binary outcomes.P<0.05 was considered significant.RESULTS Our search retrieved nine studies meeting our inclusion criteria,with a total of 129 FHFs.The results of our analysis revealed that the average operation time was 123.74 min,while the average blood loss was 491.89 mL.After an average followup of 38.4 mo,a satisfactory clinical outcome was achieved in 85%of patients,ranged from 30%to 86%,with avascular necrosis,heterotopic ossification,and osteoarthritis being the most common complications occurring at an incidence of 12%,25%,and 16%,respectively.Trochanteric flip osteotomy nonunion and trochanteric bursitis as a unique complication of SHD occurred at an incidence of 3.4%and 3.8%,respectively.CONCLUSION The integration of SHD approach for dealing with FHFs offered acceptable functional and radiological outcomes with a wide range of safety in regards to the hip joint vascularity and the development of avascular necrosis,the formation of heterotopic ossification,and the development of posttraumatic osteoarthritis;however,it still carries its unique risk of trochanteric flip osteotomy nonunion and persistent lateral thigh pain.
文摘BACKGROUND Femoroacetabular impingement(FAI)is a predisposing factor for secondary osteoarthritis of the hip joint.The two extensively described impingement mechanisms of FAI are CAM and Pincer-type.Initially managed conservatively,operative intervention should be offered to the persistently symptomatic patient.The measurement of the alpha angle is considered a standard method of assessing the severity of pathology in Cam-type FAI on pre-operative plain radiographs.The radiological correction of the alpha angle has not been previously compared between different surgical approaches.We hypothesize that there is no difference in alpha angle correction between Ganz surgical hip dislocation and the anterior mini-open approach.AIM To compare the magnitude of alpha angle correction achieved by using the Ganz surgical hip dislocation and the anterior mini-open approach.METHODS This is a retrospective study assessing seventy-nine patients identified in a 5-year period.These patients had preoperative radiographic evidence of FAI and underwent surgery by a single surgeon at our institution,a tertiary care center.Patients with missing radiographic documentation,radiographs with insufficient quality which then precluded accurate measurement of the angleα,a diagnosed congenital condition,isolated type II pathology(Pincer),and history of prior surgery were excluded from the study.Either the Ganz surgical hip dislocation or the anterior mini open approach was used.Postoperative radiographic evaluation of the alpha angle between the two surgical methods was done and corrected for age and gender using two-sample t-tests and Chi-square analyses.RESULTS A total of 79 patients met the inclusion and exclusion criteria.Forty-seven males(mean age of 35.3,range 16-53)and 32 females(mean age 36.7,range 16-60)were enrolled.Forty-seven patients underwent the anterior mini-open approach,and 32 underwent the Ganz surgical hip dislocation.There were no significant differences in age between the two surgical groups or in pre-and post-operative alpha angles based on patient gender.The mean pre-operative alpha angle for the Ganz surgical hip dislocation group was 88.0 degrees(SD 12.3)and 99.4 degrees(SD 7.2)for the anterior mini-open group.Mean post-operative angles were 49.9 degrees(SD 4.3)for the Ganz surgical hip dislocation and 43.8(SD 4.3)degrees for the anterior mini-open group.There was a statistically significant difference in patient’s pre-operative and post-operative angles(P=0.000)with both surgical approaches.CONCLUSION Statistically significant decreases in alpha angle were noted for both surgical techniques,with larger decreases seen in the anterior mini-open group.
文摘BACKGROUND:Traumatic bilateral hip dislocation is a rare condition.Anterior shoulder dislocation combined with this condition is even a rare occurrence.A 57-year-old man had bilateral asymmetric hip dislocation with a posterior wall fracture of the left acetabulum associated with right shoulder anterior dislocation caused by falling down from a cherry tree.Traumatic hip dislocation and anterior shoulder dislocation represent a true orthopedic emergency.METHODS:Closed reduction was performed immediately for three of the dislocated joints.Posterior wall fracture of the left acetabulum was treated with open reduction and internal fixation by screws.Because of the severity of associated complications like aseptic necrosis or posttraumatic osteoarthritis,efforts were made to ensure prompt diagnosis,therapy and prognosis.RESULTS:The patient was successfully treated by open reduction and internal fixation of the left acetabulum,and discharged from the hospital.CONCLUSION:Traumatic asymmetric hip dislocation and anterior shoulder dislocation are an orthopedic emergency and early diagnosis with immediate reduction of the dislocation is the key determinants of excellent result of treatment.
文摘BACKGROUND Traumatic hip dislocation usually occurs following high-velocity trauma.It is imperative that the dislocation be reduced in a timely manner,especially in a closed manner,as an orthopedic emergency.However,closed reduction can hardly be achieved in patients who also have ipsilateral lower extremity fractures.Herein,we focus on hip dislocation associated with ipsilateral lower extremity fractures,excluding intracapsular fractures(femoral head and neck fractures),present an early closed hip joint reduction method for this injury pattern,and review the literature to discuss the appropriate closed reduction technique for this rare injury pattern.CASE SUMMARY We report a case of a 37-year-old male who sustained a left acetabular posterior wall fracture,an ipsilateral comminuted subtrochanteric fracture and dislocation of the hip.The hip dislocation was reduced urgently in a closed manner using the joy-stick technique with a T-shaped Schanz screw.The fractures were reduced and fixed as a 2nd-stage surgery procedure.At the 17-month postoperative follow-up,the patient had full range of motion of the affected hip.CONCLUSION Closed reduction of a hip dislocation associated with ipsilateral lower extremity fractures is rarely achieved by regular maneuvers.Attempts at closed reduction,by means of indirectly controlling the proximal fracture fragment or reconstructing the femoral leverage rapidly with the aid of various external reduction apparatuses,were shown to be effective in some scenarios.Mandatory open reduction is indicated in cases of failed closed reduction,particularly in irreducible dislocations.
文摘Introduction: Observing and treatment of hip dysplasia in children have always been in the sphere of interest of modern molecular medicine. The role of molecular factors in the formation of connective tissue dysplasia in children is considered crucial for such multisystem disorders, and connective tissue dysplasia progressing involves immune system parameters and biochemical markers. The aim of this work was to establish the relationship between immune status indicators and biochemical markers of connective tissue using bioinformatics and modeling methods. Materials and Methods: 27 patients with congenital hip dislocation, admitted to the University Clinic of Privolzhsky Research Medical University, Department of children orthopedics for surgical treatment, were examined. Determination of 10 blood parameters was conducted by modern biochemical and immunological methods. Statistica 12.0 software from StatSoft was used for statistical data processing. Methods of nonparametric statistics were used since the samples in the control group partially follow the normal distribution. Correlation methods and regression modeling methods were used to evaluate the relationship of indicators. Results and Conclusion: In our investigation we have shown the presence of statistical and mathematical interactions between the parameters of innate immunity and indicators of connective tissue metabolism. The leading role of the immune system in the development of pathologies associated with connective tissue dysplasia is assumed. In further investigations it is necessary to clarify the role hypoxia in HIF-1 stimulated control of skeletal dysplasia, collagen modification, connective tissue dysplasia development.
文摘Posterior hip dislocation with greater trochanter fracture is an uncommon injury pattern in the acute trauma patient. Frequently associated injury includes a combination of hip dislocation with posterior wall of acetabulum, head of femur fracture, intertrochanteric fracture and even the most severe type of combined acetabular fracture. We report a 42-year-old man post traumatic bilateral hip injuries with irreducible posterior hip dislocation and associated isolated greater trochanteric fracture successfully managed with open reduction and fixation of greater trochanter with universal locking trochanteric stabilization plate.
文摘Objective: to explore the effect of early rehabilitation nursing intervention on the prognosis of children with developmental hip dislocation. Methods: 82 cases of pediatric developmental hip dislocation from May 2018 to September 2020 in our department were taken as the observation objects, and divided into the rehabilitation group and the basic group, using early rehabilitation nursing and using basic nursing respectively. Results: in comparison of FMA and VAS scores after nursing between the rehabilitation group and the basic group, those in the rehabilitation group were 27.58±3.77 (points) and 2.01±0.22 (points), respectively, and those in the basic group were 19.85±2.89 (points) and 3.87±0.52 (points), respectively (t = 9.852, P =0.000). The results were different. Conclusion: the effect of early rehabilitation nursing after the operation of children with developmental dislocation of hip joint is good and the method can be popularized.
文摘BACKGROUND Developmental dysplasia of the hip(DDH)remains a significant public health challenge,particularly in developing countries where cultural factors and limited access to appropriate medical equipment complicate optimal management.AIM To evaluate the difficulties encountered in the management of DDH in our healthcare setting.METHODS A retrospective,single-center study was conducted over nine years(2015-2023),including 20 patients(26 hips)with idiopathic DDH.Patients with post-traumatic or post-infectious hip dislocations were excluded.Data collected included age at diagnosis,laterality,Tönnis classification,duration of traction,and surgical interventions.RESULTS The mean age at diagnosis was 35.6 months(4 months to 10.8 years).Dislocation was unilateral in 70%of cases;69.2%were classified as Tönnis stage 3 or 4.The average traction duration was 57.5 days.Surgery was performed in 8 hips.Among 16 patients with regular follow-up,10 showed good outcomes,3 excellent,and 3 fair according to the McKay score.Older age at treatment(>1 year),bilateral dislocation,and higher severity(Tönnis stages 3 and 4)were associated with worse functional outcomes.No significant correlation was found between functional and radiological results.Residual dysplasia occurred in 3 patients,and 1 re-dislocation was noted.CONCLUSION Delayed diagnosis and advanced severity at presentation are key challenges in managing DDH in our context.Nevertheless,appropriate management can achieve generally favorable outcomes,despite complications linked to prolonged treatment and resource limitations.
文摘Bilateral hip dislocation rarely occurs. In this paper, a case of bilateral hip dislocation associated with bilateral sciatic nerve palsy resulted from a road traffic accident is reported. Both hips were emergently reduced under general anaesthesia. Acetabular reconstruction was done bilaterally due to the unstable hips. The patient subsequently developed heterotopic ossification and avascular necrosis on the left hip and underwent total hip arthroplasty. The sciatic nerve on the right side achieved complete recovery but that on the left side only partly recovered and was augmented by tendon transfer. Such injuries are serious and one should be aware of the complications because they can resurface and so patients should be followed up for a long time. To the best of our knowledge, this kind of injury has not been reported in the English .language literature.
文摘Femoral head fractures without disloca- tion or subluxation are extremely rare injuries. We report a neglected case of isolated comminuted fracture of femoral head without hip dislocation or subluxation of one year duration in a 36-year-old patient who sustained a high en- ergy trauma due to road traffic accident. He presented with painful right hip and inability to bear full weight on right lower limb with Harris hip score of 39. He received cementless total hip replacement. At latest follow-up of 2.3 years, functional outcome was excellent with Harris hip score of 95. Such isolated injuries have been described only once in the literature and have not been classified till now. The purpose of this report is to highlight the extreme rarity, pos- sible mechanism involved and a novel classification system to classify such injuries.
文摘Traumatic posterior hip dislocation is an uncommon injury in children, constituting less than 5% of paediatric dislocations. In a younger child （〈5 years）, minor trauma such as a slip or fall from a low height may cause a hip dislocation, whereas in an adolescent a dislocation is usually caused by a major trauma such as motor vehicle accident. In this case report we present a rare case of trau- matic hip dislocation in a 16-month-old girl. Early detectionand closed reduction ensured good outcome in our case. A high index of suspicion is necessary to achieve satisfactory reduction within six hours of dislocation because reduction after this period will greatly increase the risk of complications.
文摘The authors reported the case of a 27- year-old man who sustained an irreducible postero-lateral traumatic dislocation of the hip with capsular and labral entrapment. Initial X-rays showed only a small acetabular fragment. After two attempts to reduce the hip with muscle paralysis under general anaesthesia failed, the patient was treated by immediate open reduction through a posterolateral approach. Surgical exploration of the hip revealed a small osteochondral fragment attached to a large piece of labrum and capsule, clogging the acetabulum. The femoralhead crossed over the torn capsule with a buttonhole effect. These elements were relieved, the bone fragment was fixed with a 2 mm screw and the capsule was repaired. At the 10- year follow-up, the functional outcome was excellent with a Harris score of 100 points and no signs of necrosis or osteoarthritis. The authors propose a literature review of this uncommon lesion.
基金The Grant of Xiangya Famous Doctors of Central South University,No.201468.
文摘Obturator dislocation is a rare type of hip dislocation,accounting for about 2%-5%of all hip dislocations.The occurrence of old unreduced obturator dislocation is even more infrequent,with only 17 cases reported in nine studies,most of which were from the 1950s to 1980s in developing countries.CASE SUMMARY A 38-year-old woman from Hunan Province,China presented with stiffness of the left hip in abduction,flexion,and external rotation after falling from a 2-meter-tall tree onto her left knee 1.5 mo prior.Pelvic radiograph and computed tomography revealed obturator dislocation of the left hip accompanied by impaction fracture at the superolateral aspect of the left femoral head without associated acetabulum fracture.Open reduction was performed,resulting in restoration of the concentric alignment of the left hip.After surgery,6-wk skin traction was applied and the patient was kept in bed for an additional 2 wk.At 3 mo after surgery,the patient reported experiencing some pain,which did not affect the function of the affected limb,and some movement restriction but no abduction deformity or claudication was present.An X-ray showed that the left hip was homocentric,and there was no sign of posttraumatic arthritis or avascular necrosis.CONCLUSION Open reduction may be an effective treatment strategy for the rare condition of old unreduced obturator dislocation with short neglect time.
文摘Traumatic hip dislocations occur in children below 15 years old. Just as in adults, posterior hip dislocations are 10 times more common than anterior hip dislocations. Traumatic hip dislocation in pediatric
文摘Objective To explore the causes and management of prosthesis disocation after artificaial hip replacement (AHR).Methods Seventeen patients with prosthesis dislocation after AHR during January 2000 to July 2010 were studied
文摘This paper discussed the injury mechanism and management of a patient who had concomitant ipsilateral hip and knee dislocations and contralateral open leg fracture. A 32-year-old man presented with ipsilateral fracturedislocations of the left hip （Pipkin＇s type IV） and knee （Moore II）joints and contralateral open fracture of the leg bones after a car accident. After emergency resuscitative measures, the hip joint was reduced and Pipkin＇s fracture was fixed using Ganz approach with lag screws; knee joint was reduced closely and tibial plateau fracture was stabilized with lateral buttress plate and a transarticular spanning fixator. The open fracture on the other leg was debrided and fixed with an external fixator. There was no insta-bility in both joints after fixation when he was examined under anesthesia. The fractures united after 3 months and the patient had no residual instability of hip and knee. There was no clinical or radiological evidence of osteonecrosis in the hip joint after 6 months. At one-year follow-up, he had satisfactory functional outcome with almost normal range of motion at both joints. Ipsilateral hip and knee dislocations are rare injuries and more caution is needed for early diagnosis. A timely appropriate intervention can provide good functional outcome to the patient in this situation.
文摘Traumatic posterior dislocation of hip associated with ipsilateral displaced femoral neck fracture is a rare injury. Moreover, the management of such patients evokes strong views regarding primary replacement or preserving the femoral head. We presented a case of young adult with such an injury. He was operated upon with reduction of the dislocation and fixation of femoral neck fracture with the help of cancellous screws. Two years later, the fracture had united and the patient was asymptomatic. We further proposed the mechanism of injury for such a fracture and discussed the management in the changing trauma scenario of the developing world.
文摘Inferior hip dislocation is the rarest type among all hip dislocations. Very few cases have been re ported in the English literature. Most of the earlier reported cases involves the pediatric age group. No single case series could be found in the English literature. We came across 4 cases of inferior hip dislocation with a varied age profile （range 10 to 56 years, mean 33.8 years）. Patients with this disease usually complained of pain and kept the thigh flexed and abducted. The diagnosis can be confirmed by radiographs which reveal that the long axis of the femur varies in alignment with respect to the spine from parallel toan angle almost 90° away from the axis. In our series, closed reduction was successful in all patients, either under seda tion or general anaesthesia. Skin traction for a period of 6 weeks was applied in all of them and followup revealed painfree, stable and mobile hips. In this study we present the details of these cases along with a review of literature discussing the various modes and mechanisms that pro duce inferior hip dislocation.
文摘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 across a 30- year-old patient with a bilateral inferior hip dislocation. He had sustained a road traffic accident and the attitude of both hip joints was flexion and abduction. The diagnosis was confirmed by radiographs which revealed the long axis of the femur at an angle of 1 l0 （right） degrees and 100 （left）degrees respectively away from the axis. Closed reduction under sedation was successfully performed. Skin traction for a period of 6 weeks was advised and the follow-up revealed an excellent result. We present the details of this case, the first of its kind along with a review of the literature, discussing the various modes and mechanisms of injury inducing inferior dislocation of the hip.
