Usefulness of arthroscopic surgery in hip trauma cases

• Published in: Arthroscopy Vol. 19; no. 3; p. 269
• Main Authors: Yamamoto, Yasuhiro, Ide, Takatoshi, Ono, Takashi, Hamada, Yoshiki
• Format: Journal Article
• Language: English
• Published: United States 01.03.2003
• Subjects: Accidents, Traffic; Acetabulum - injuries; Acetabulum - surgery; Adult; Arthroscopy; Bone Nails; Debridement; Female; Femoral Fractures - diagnostic imaging; Femoral Fractures - etiology; Femoral Fractures - surgery; Femur Head - injuries; Femur Head - surgery; Femur Head Necrosis - etiology; Follow-Up Studies; Fracture Fixation, Internal - methods; Fractures, Bone - etiology; Fractures, Bone - surgery; Hip Dislocation - etiology; Hip Dislocation - surgery; Hip Injuries - complications; Hip Injuries - surgery; Humans; Joint Loose Bodies - etiology; Joint Loose Bodies - surgery; Male; Middle Aged; Osteoarthritis, Hip - etiology; Osteoarthritis, Hip - prevention & control; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Radiography; Therapeutic Irrigation; Treatment Outcome
• DOI: 10.1053/jars.2003.50033

The goal of this study is to clarify the usefulness of arthroscopic surgery as an adjunct in the management of hip trauma. Clinical case series. Eleven joints from 10 hip trauma cases were studied. All joints had been injured in traffic accidents. Seven joints were classified as Thompson and Epstein (T-E) type I, 2 joints as type II, and 1 joint as type IV. The remaining case was a fracture of the acetabular weight-bearing region that was not included within these classifications. The 5 femoral head fractures associated with hip dislocation were further classified according to Pipkin: 3 joints were type 1, 1 joint was type 2, and 1 joint was type 3. The interval from injury to arthroscopy ranged from 1 to 7 days, with a mean of 3.2 days. In 7 cases, small free osteochondral or chondral fragments that were not detectable on either plain radiographs or computed tomography scans were seen arthroscopically. These fragments were debrided. Arthroscopic osteosynthesis using absorbable pins and fragment extraction were performed in 1 case each of the Pipkin's type 1 femoral head fractures. In the case of the acetabular weight-bearing region fracture, reduction and percutaneous pinning were performed under arthroscopic observation. After a mean postoperative follow-up period of 9 years and 6 months, no abnormalities were observed in 9 of the joints. However, the T-E type IV joint developed osteoarthritis and the Pipkin type 3 joint developed aseptic osteonecrosis of the femoral head. Arthroscopic surgery allows procedures such as washout and debridement of small free osteochondral and chondral fragments, which were previously neglected in T-E type I and II dislocations despite the fact that they may cause osteoarthritis. In addition, arthroscopic surgery allows procedures such as the extraction or osteosynthesis of fracture fragments in cases associated with femoral head fractures.