Abstract
Background
Intra-articular loose bodies following simple dislocations can lead to early degeneration. Nonconcentric reduction may indicate retained loose bodies and offer a method to identify patients requiring exploration so that this undesirable outcome can be avoided.
Materials and Methods
One hundred and seventeen consecutive simple dislocations of the hip presenting to the hospital from January 2000 to June 2006 were assessed for congruency after reduction by fluoroscopic assessment of passive motion in the operating room as well as with good quality radiographs. Computerized tomography (CT) scan with 2-mm cuts was done for confirmation of reduction and to identify the anatomy of loose bodies. Patients with nonconcentric reduction underwent open exploration to identify the etiology of the dislocation and for removal of loose bodies. Thomson and Epstein clinical and radiological criteria were used to assess the outcome.
Results
Twelve of the one hundred and seventeen (10%) dislocations had incongruent reduction, which was identified by the break in Shenton’s line and increase in medial joint space in seven patients, increase in the superior joint space in three patients, or increase in the joint space as a whole in two patients. CT scan identified the origin of the osteocartilaginous fragment as being from the acetabulum in six patients, the femoral head in four, and from both in one. One patient had an inverted posterior labrum. Following debridement, congruent reduction was achieved in all patients. At an average follow-up of 5 years (range: 2 years 5 months to 8 years), the outcome as evaluated by Thompson and Epstein clinical criteria was excellent in eleven cases and good in one case; the radiological outcome was excellent in eight cases and good in four cases.
Conclusions
Intra-articular loose bodies were identified by nonconcentric reduction in 12 out of 117 patients with simple hip dislocation. Careful evaluation by fluoroscopy and good quality radiographs are indicated following reduction of hip dislocations.
Similar content being viewed by others
References
Goulet JA, Levin PE. Hip Dislocations, In Browner BD, Levine AM, Jupiter JB, Trafton P G and Krettek C (eds). Skeletal Trauma. 3rd ed. Philadelphia, Saunders; 2003.
Tornetta P, Hip Dislocations and Fractures of the Femoral Head. In Bucholz RW, Heckman JD, Court-Brown CM (eds). Rockwood and Green’s Fractures in Adults. 6th ed. Philadelphia, Lippincott Williams and Wilkins; 2006.
Bray EA. Traumatic dislocations of the hip. Army experience and results over a twelve-year period. J Bone Joint Surg Am 1962;44-A:1115–34.
Hougaard K, Lindequist S, Nielsen LB. Computerised tomography after posterior dislocation of the hip. J Bone Joint Surg Br 1987;69:556–7.
Canale ST, Manugian AH. Irreducible traumatic dislocations of the hip. J Bone Joint Surg Am 1979;61:7–14.
Epstein HC. Posterior fracture-dislocations of the hip: Longterm follow up. J Bone Joint Surg Am 1974;56:1103–27.
Tile M, Fractures of the Acetabulum. In Schatzker J, Tile M, Axelrod TS, Hu R, Stephen D (eds) The rationale of operative fracture care. 3rd ed. Berlin, Springer 2005.
Baird RA, Schobert WE, Pais MJ, Ahmed M, Wilson WJ, Farjalla GL, et al. Radiographic identification of loose bodies in the traumatized hip joint. Radiology 1982;145:661–5.
Calkins MS, Zych G, Latta L, Borja FJ, Mnaymneh W. Computed tomography evaluation of stability in posterior fracture dislocation of the hip. Clin Orthop Relat Res 1988;227:152–63.
Thompson VP, Epstein HC. Traumatic dislocations of the hip; a survey of two hundred and four cases covering a period of twenty-one years. J Bone Joint Surg Am 1951;33-A:746–78.
Rodríguez-Merchán EC. Coxarthrosis after traumatic hip dislocation in the adult. Clin Orthop Relat Res 2000;377:92–8.
Hougaard K, Thomsen PB. Traumatic posterior dislocation of the hip-prognostic factors influencing the incidence of avascular necrosis of the femoral head. Arch Orthop Trauma Surg 1986;106:32–5.
Durakbasa O, Okan N, Canbora K, Görgeç M. Factors affecting the results of treatment in traumatic dislocation of the hip. Acta Orthop Traumatol Turc 2005;39:133–41.
Brooks RA, Ribbans WJ. Diagnosis and imaging studies of traumatic hip dislocations in the adult. Clin Orthop Relat Res 2000;377:15–23.
Altenberg AR. Acetabular labrum tears: A cause of hip pain and degenerative arthritis. South Med J 1977;70:174–5.
Liporace FA, Dasti UR, Raiszadeh K. Ipsilateral anterior then irreducible posterior hip dislocation without fracture: A case report. J Orthop Trauma 2008;22:363–7.
Siboto GM, von Bormann RP, Alexander G. Diagnosis of simple posterior hip dislocation: Obturator oblique radiographic views exclude the need for CT scan. J Bone Joint Surg Br 2005;87-B:277.
Frick SL, Sims SH. Is computed tomography useful after simple posterior hip dislocation? J Orthop Trauma 1995;9:388–91.
Harley JD, Mack LA, Winquist RA. CT of acetabular fractures: Comparison with conventional radiography. AJR Am J Roentgenol 1982;138:413–7.
Alonso JE, Volgas DA, Giordano V, Stannard JP. A review of the treatment of hip dislocations associated with acetabular fractures. Clin Orthop Relat Res 2000;377:32–43.
Price CT, Pyevich MT, Knapp DR, Phillips JH, Hawker JJ. Traumatic hip dislocation with spontaneous incomplete reduction: A diagnostic trap. J Orthop Trauma 2002;16:730–5.
Gennari JM, Merrot T, Bergoin V, Turcat Y, Bergoin M. X-ray transparency interpositions after reduction of traumatic dislocations of the hip in children. Eur J Pediatr Surg 1996;6:288–93.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Karthik, K., Sundararajan, S.R., Dheenadhayalan, J. et al. Incongruent reduction following post-traumatic hip dislocations as an indicator of intra-articular loose bodies: A prospective study of 117 dislocations. IJOO 45, 33–38 (2011). https://doi.org/10.4103/0019-5413.73650
Published:
Issue Date:
DOI: https://doi.org/10.4103/0019-5413.73650