Campbell Clinic, Memphis, TN.
Department of Orthopedic Surgery, Nationwide Children's Hospital.
J Pediatr Orthop. 2024;44(5):e433-e438. doi: 10.1097/BPO.0000000000002657. Epub 2024 Mar 8.
Traumatic, posterior hip dislocations in the pediatric population are typically managed by closed reduction to achieve a concentric hip joint. The presence of an acetabular "fleck" sign, despite concentric reduction, has been shown to signify significant hip pathology. The purpose of this study was to evaluate the outcomes of open labral repair through a surgical hip dislocation (SHD) in a consecutive series of patients with an acetabular "fleck" sign associated with a traumatic hip dislocation/subluxation.
A retrospective review of patients between 2008 and 2022 who presented to a single, level 1 pediatric trauma center with a traumatic posterior hip dislocation/subluxation was performed. Patients were included if they had an acetabular "fleck" sign on advanced imaging and underwent open labral repair through SHD. Medical records were reviewed for sex, age, laterality, mechanism of injury (MOI), and associated orthopaedic injuries. The modified Harris hip score (mHHS) was utilized as the primary clinical outcomes measure. Patients were assessed for the presence of heterotopic ossification (HO) and complications, including implant issues, infection, avascular necrosis (AVN), and post-traumatic dysplasia.
Twenty-nine patients (23 male, average age: 13.0±2.7 y; range: 5.2 to 17.3) were identified. Eighteen injuries were sports related, 9 caused by motor vehicle accidents, and 1 pedestrian struck. All patients were found to have an acetabular "fleck" sign on CT (26 patients) or MRI (5 patients). Associated injuries included: femoral head fracture (n=6), pelvic ring injury (n=3), ipsilateral femur fracture (n=2), and ipsilateral PCL avulsion (n=1). At the latest follow-up (2.2±1.4 y), all patients had returned to preinjury activity/sport. Three patients developed asymptomatic, grade 1 HO in the greater trochanter region. There was no incidence of AVN. One patient developed post-traumatic acetabular dysplasia due to early triradiate closure. mHHS scores showed excellent outcomes (n=21, 94.9±7.4, range: 81 to 100.1).
The acetabular "fleck" sign indicates a consistent pattern of osteochondral avulsion of the posterior/superior labrum. Restoring native hip anatomy and stability is likely to improve outcomes. SHD with open labral repair in these patients produces excellent clinical outcomes, with no reported cases of AVN.
Level IV-therapeutic.
儿童外伤性髋关节后脱位通常通过闭合复位来实现同心髋关节。尽管复位同心，但髋臼“斑点”征的存在表明存在显著的髋关节病理。本研究的目的是评估在连续一系列伴有髋臼“斑点”征的创伤性髋关节脱位/半脱位患者中，通过手术髋关节脱位（SHD）进行开放式盂唇修复的结果。
对 2008 年至 2022 年期间在一家单一的、1 级儿童创伤中心就诊的外伤性后髋关节脱位/半脱位患者进行了回顾性研究。如果患者在高级影像学上有髋臼“斑点”征，并通过 SHD 进行开放性盂唇修复，则将其纳入研究。对患者的性别、年龄、侧别、损伤机制（MOI）和相关的骨科损伤进行了回顾。采用改良 Harris 髋关节评分（mHHS）作为主要临床疗效指标。评估患者是否存在异位骨化（HO）和并发症，包括植入物问题、感染、股骨头坏死（AVN）和创伤后发育不良。
共确定 29 例患者（23 例男性，平均年龄 13.0±2.7 岁；范围 5.2 至 17.3 岁）。18 例损伤与运动有关，9 例由机动车事故引起，1 例行人受伤。所有患者在 CT（26 例）或 MRI（5 例）上均发现髋臼“斑点”征。相关损伤包括：股骨头骨折（n=6）、骨盆环损伤（n=3）、同侧股骨骨折（n=2）和同侧后交叉韧带撕脱（n=1）。在最近的随访（2.2±1.4 年）时，所有患者均已恢复到受伤前的活动/运动水平。3 例患者在大转子区域出现无症状、1 级 HO。没有股骨头坏死的发生。1 例患者由于早期三辐射闭合而发生创伤性髋臼发育不良。mHHS 评分显示出优异的结果（n=21，94.9±7.4，范围 81 至 100.1）。
髋臼“斑点”征表明存在后/上盂唇的骨软骨撕脱一致模式。恢复原生髋关节解剖结构和稳定性可能会改善结果。在这些患者中，通过 SHD 进行开放性盂唇修复可产生优异的临床效果，且无股骨头坏死的报告病例。
IV 级-治疗。
