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Pelvic, acetabular, and hip fractures have a very high incidence of catastrophic early and late complications. In the emergency department, attention should be focused on the prompt and judicious management of concurrent local visceral and systemic problems. The eventual outcome of any pelvic or hip injury reflects the adequacy of the emergency treatment.
Hip arthroscopy is an excellent way to evaluate, diagnose, and treat acetabular labral and chondral lesions. It is minimally invasive and can be done on an outpatient basis. Candidates for hip arthroscopy will have functionally limiting symptoms and reproducible physical findings. Patients will often have mechanical symptoms such as clicking, catching, locking, or giving way. Symptoms may be preceded by a traumatic event such as a fall or twisting injury or may have an insidious onset. Radiographic studies are not sensitive enough to diagnose intra-articular hip pathology; however, contrast agents used in conjunction with CT and MRI may aid in the diagnosis. Therefore, a high level of clinical suspicion and prudent clinical judgment are warranted. A thorough knowledge of positioning and anatomic relationships to portal placement is necessary to prevent potential neurovascular complications from occurring during hip arthroscopy. Labral tears are the most common cause of mechanical hip symptoms. Tears occur anteriorly, and associated chondral lesions are common. The severity of the chondral lesion is highly correlated with the surgical outcome. The most frequently observed chondral lesion is the watershed lesion, which consists of a labral tear with separation of the labrum from the articular surface at the labral-cartilage junction. The difficulty in identifying these lesions as well as their effect on outcome provides a convincing rationale for arthroscopic hip surgery. Arthroscopic treatment of these tears involves judicious debridement back to a stable base while carefully preserving the capsular labral tissue. Eliminating the source of mechanical symptoms secondary to labral pathology should alleviate the patient's discomfort. Chondral defects are drilled or treated with a microfracture technique to enhance fibrocartilage formation. Patient outcomes are directly dependent on the stage or extent of the labral and chondral lesion.
Implantation of total endoprosthesis (TEP) is an established method for the operative therapy of acute and chronic hip dysfunction. Beside septic complications iatrogenic injuries of the vascular system regularly occur. Immediate and adequate therapy is necessary in order to prevent loss of an extremity or even patients death. We present three patients with major vascular injuries during hip joint operations. In two patients was the external iliac artery and in one the femoral common artery injured. The cases were managed with PTFE- or Dacron-interposition. The problem of vascular injuries associated with the implantation of total hip joint endoprosthesis will be discussed and the avoidable of most vascular lesions is underlined.
OBJECTIVE: To report the current knowledge of the diagnosis and treatment of acetabular labral tears. METHODS: A search of the MEDLINE, CINAHL, and Science Direct indexing systems (1966 to September 2004) was conducted using the following key indexing terms: labrum, labral, hip, acetabulum, injury, and treatment. One hundred eighty-six publications were sourced using this methodology and were considered in this review. The literature was sorted according to publication date and relevance. RESULTS: There is a small amount of literature on the topic of labral lesions. This is particularly true of the use of conservative (manual therapy) methods for the treatment of labral lesions. The literature on surgical diagnosis and management is more mature; however, longer-term follow-up studies are required to conclusively show the benefit of surgical intervention. CONCLUSIONS: Early diagnosis is important as labral tears may be linked to the progression of hip osteoarthritis. Initial treatment consisting of partial weight-bearing may respond if initiated early. Arthroscopy currently represents the gold standard in both the diagnosis and treatment of labral tears. Future research must investigate the long-term outcomes of partial labrectomy, as well as the efficacy of conservative approaches to care.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
This study describes in modern medical terms a traumatic hip injury suffered by the Biblical patriarch Jacob approximately 3,500 years ago. The case history is based on the original Hebrew text found in the Bible book of Genesis (Chapter 32:25-33) as interpreted by traditional Jewish commentaries on the Bible. Jacob sustained a hip injury in hand-to-hand combat with an adversary or through an intense physiological reaction to a prophetic vision of such a battle. He appears to have sustained neurological injury to his sciatic nerve as well as musculoskeletal damage to his hip. These injuries caused a temporary limping gait. Jacob probably sustained a neurapraxia of the sciatic nerve. The differential diagnosis of his musculoskeletal hip injury includes hip dislocation, fracture, soft tissue trauma, and articular pathology.
Knee and hip problems account for up to 40% of injuries in classical ballet. Despite apparent flexibility, many dancers appeared to have tight iliotibial bands that contributed to lower limb problems. Thirty senior female ballet dancers were contrasted with thirty age-matched active volunteers for hip and knee range of motion, and the information derived was correlated with their orthopaedic medical histories. Dancers spent a reasonable period of time warming up, but it was usually with an unbalanced routine that emphasized hip abduction and external rotation to the exclusion of adduction work. This was reflected in the significantly lower range of passive hip adduction and internal rotation compared to the controls. Furthermore, the older and more experienced the dancer, the more this trend was exaggerated. This unbalanced flexibility may play a role in the production of lateral knee pain (30% of the dancers) and anterior hip pain (33% of the dancers). It is suggested that more attention should be given to a balanced stretching regimen as part of the dancers' warmup in an effort to reduce the frequency of some of the chronic hip and knee complaints.
PURPOSE: To report endovascular repair of injuries to the external iliac artery during hip surgery. CASE REPORTS: Two elderly women with histories of chronically infected hip prostheses were found to have iatrogenic leaking pseudoaneurysms of the external iliac artery due to hip surgery trauma in the past. Both were treated successfully with a Jostent Peripheral Stent-Graft. The first patient died 17 months after treatment, and the second was well, with an excluded false aneurysm, at the 6-month follow-up. CONCLUSIONS: Stent-graft repair may be an appropriate and effective treatment for some traumatic arterial lesions.
METHODS: The authors conducted a survey of 296 competitive swimmers to assess the incidence and importance of interfering groin pain in breaststroke swimmers. RESULTS: Breaststroke swimmers were more likely to have current groin pain (6.92%) than individual medley swimmers who did not compete in pure breaststroke events (0, P = 0.015). Breaststroke swimmers (42.7%) were also more likely than individual medley swimmers (21.5%, P = 0.000622) or nonbreaststroke, nonindividual medley swimmers (5.8%, P = 0.00000311) to have been unable to train breaststroke in practice during the past year due to groin injury. CONCLUSION: Results indicate that breaststroke swimmers are at significant risk of groin injury, groin injury is positively correlated with increased magnitude of breaststroke training, and groin injury may prevent participation in practices and competitions.
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Labral tears in athletes can lead to disabling hip pain and affect their athletic performance. Other intra-articular lesions, including chondral injuries, capsular abnormalities, and ligamentum teres tears, commonly coexist with acetabular labral tears. Isolated athletic injury or repetitive traumatic activity can lead to labral tears; however, underlying structural (femoroacetabular impingement) and developmental abnormalities predisposing athletes to labral pathology must be addressed. Recent studies have demonstrated lesions associated with acetabular labral tears, and that labral tears rarely occur as isolated injuries. Return to sport is favorable in athletes who have labral tears if they are properly treated with arthroscopic intervention.
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Acute osteochondral injuries of the hip are rare in the absence of associated dislocation. A series of cases is presented in which these injuries were sustained after relatively minor trauma to the hip. Radiologic studies revealed evidence of mild hip dysplasia and, in one case, an osteochondral fracture of the right femoral head. Scintigraphy revealed the fracture and unexpected uptake in the acetabulum, which was subsequently confirmed as being due to labral tears or acetabular osteochondral injuries. In addition, the scan showed evidence of a possible avulsion-type injury of the iliofemoral ligament, suggesting the mechanism of subluxation.
The runner is especially at risk for development of injury to the hip and pelvis secondary to chronic repetitive microtrauma. The key to treatment is establishing complete and accurate diagnosis, and, in particular, identifying the functional biomechanical deficits in the kinetic chain that contribute to this repetitive microtrauma. A long-term successful outcome and prevention of reinjury are more likely if the focus of rehabilitation is on the restoration of the functional kinetic chain, rather than on a specific injured tissue. For example, the typical treatment of "iliotibial band syndrome" is a stretching protocol that frequently is unsuccessful in the long-term improvement of symptoms. A functional biomechanical approach might identify that the injured runner has lack of calcaneal eversion and a structurally rigid supinated foot. These functional biomechanical deficits would lead to inadequate internal rotation of the tibia and femur and result in inhibition or decreased recruitment of the gluteal muscles, in particular the gluteus medius. Restoring pronation throughout the lower extremity would require joint play techniques or functional joint mobilizations for the foot and ankle. In addition, a running shoe with a cushioned heel may be necessary to promote pronation and to attenuate shock. Exercises that integrate foot and hip function, including balance reaches, lunges and step-downs, are prescribed to stimulate the gluteus medius and other gluteals in positions that simulate running. Activities that are done in this manner activate the entire functional kinetic chain of muscles and joints. The nonoperative sports medicine specialist, in particular the physiatrist and physical therapist, are in an excellent position to integrate treatment of the entire functional kinetic chain through a thorough biomechanical evaluation and comprehensive rehabilitation of the injured runner. Additional training in the areas of biomechanical evaluation and functional biomechanical deficits should be sought, because residency and even many fellowship-trained programs often overlook these important areas. Finally, the injured runner is best taken care of in a setting in which different sports medicine specialists are available and work well as a team. No one sports medicine specialist can provide all of the needs to the injured runner.
Normal hip disorders do not account for a large proportion of exercise-related injuries, but they can pose a clinical dilemma because symptoms tend to be nonspecific. Conventional radiographs may demonstrate some causes of hip pain, such as stress fractures and degenerative joint disease. Magnetic resonance imaging (MRI) of the hip has proven valuable in the diagnosis of radiographically occult osseous abnormalities and periarticular soft-tissue disorders such as stress fractures, avulsion injuries, musculotendinous abnormalities, and bursitis. Conventional MRI has been less useful in the evaluation of intra-articular lesions, including acetabular labral tears, intra-articular loose bodies, and cartilage lesions. Visualization of intra-articular structures and their abnormalities can be improved by injection of diluted gadolinium, which distends the capsule and leaks into labral tears. This article focuses on the use of conventional radiography and MRI in recreational and professional athletes with painful hip joints. Where possible, MRI is compared with other diagnostic modalities such as bone scan and computed tomography.