Acetabular "Fleck" Sign: Outcomes of Surgical Repair.
Journal
Journal of pediatric orthopedics
ISSN: 1539-2570
Titre abrégé: J Pediatr Orthop
Pays: United States
ID NLM: 8109053
Informations de publication
Date de publication:
08 Mar 2024
08 Mar 2024
Historique:
medline:
8
3
2024
pubmed:
8
3
2024
entrez:
8
3
2024
Statut:
aheadofprint
Résumé
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.
Sections du résumé
BACKGROUND
BACKGROUND
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.
METHODS
METHODS
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.
RESULTS
RESULTS
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).
CONCLUSIONS
CONCLUSIONS
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 OF EVIDENCE
METHODS
Level IV-therapeutic.
Identifiants
pubmed: 38454629
doi: 10.1097/BPO.0000000000002657
pii: 01241398-990000000-00503
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Hung NN. Traumatic hip dislocation in children. J Pediatr Orthop B. 2012;21:542–551.
Macfarlane I, King D. Traumatic dislocation of the hip joint in children. Aust NZJ Surg. 1976;46:227–231.
Macnicol MF. The Scottish incidence of traumatic dislocation of the hip in childhood. J Pediatr Orthop B. 2000;9:122–124.
Vialle R, Odent T, Pannier S, et al. Traumatic hip dislocation in childhood. J Pediatr Orthop. 2005;25:138–144.
Mehlman CT, Hubbard GW, Crawford AH, et al. Traumatic hip dislocation in children. Long-term followup of 42 patients. Clin Orthop Relat Res. 2000:68–79.
Vialle R, Pannier S, Odent T, et al. Imaging of traumatic dislocation of the hip in childhood. Pediatr Radiol. 2004;34:970–979.
Baumann AN, Ndjonko LCM, Schoenecker JG, et al. Clinical outcomes and associated pathologies following pediatric traumatic hip dislocations: a systematic review of the literature. J Pediatr Orthop. 2024;44:e97–e105.
Blanchard C, Kushare I, Boyles A, et al. Traumatic, posterior pediatric hip dislocations with associated posterior labrum osteochondral avulsion: recognizing the acetabular “fleck” sign. J Pediatr Orthop. 2016;36:602–607.
Thanacharoenpanich S, Bixby S, Breen MA, et al. MRI is better than CT scan for detection of structural pathologies after traumatic posterior hip dislocations in children and adolescents. J Pediatr Orthop. 2020;40:86–92.
Rubel IF, Kloen P, Potter HG, et al. MRI assessment of the posterior acetabular wall fracture in traumatic dislocation of the hip in children. Pediatr Radiol. 2002;32:435–439.
Nepple JJ, Philippon MJ, Campbell KJ, et al. The hip fluid seal. Part II: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip stability to distraction. Knee Surg Sports Traumatol Arthrosc. 2014;22:730–736.
Philippon MJ, Nepple JJ, Campbell KJ, et al. The hip fluid seal. Part I: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip fluid pressurization. Knee Surg Sports Traumatol Arthrosc. 2014;22:722–729.
Dwyer MK, Jones HL, Hogan MG, et al. The acetabular labrum regulates fluid circulation of the hip joint during functional activities. Am J Sports Med. 2014;42:812–819.
Kim YT, Azuma H. The nerve endings of the acetabular labrum. Clin Orthop Relat Res. 1995:176–181.
Podeszwa DA, De La Rocha A, Larson AN, et al. Surgical hip dislocation is safe and effective following acute traumatic hip instability in the adolescent. J Pediatr Orthop. 2015;35:435–442.
Novais EN, Heare TC, Hill MK, et al. Surgical hip dislocation for the treatment of intra-articular injuries and hip instability following traumatic posterior dislocation in children and adolescents. J Pediatr Orthop. 2016;36:673–679.
Morris AC, Yu JC, Gilbert SR. Arthroscopic treatment of traumatic hip dislocations in children and adolescents: a preliminary study. J Pediatr Orthop. 2017;37:435–439.
Khanna V, Harris A, Farrokhyar F, et al. Hip arthroscopy: prevalence of intra-articular pathologic findings after traumatic injury of the hip. Arthroscopy. 2014;30:299–304.