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CASE REPORT Table of Contents   
Year : 2005  |  Volume : 39  |  Issue : 3  |  Page : 191-192
Arthroscopic fracture fragment removal from the hip - A case report


1 Division of Arthroscopy & Knee Surgery, Orthopaedics & Trauma Surgery Institute, Amrita Institute of Medical Sciences, Kochi, India
2 Division of Adult Reconstruction, Orthopaedics & Trauma Surgery Institute, Amrita Institute of Medical Sciences, Kochi, India

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How to cite this article:
Thilak J, Varughese J. Arthroscopic fracture fragment removal from the hip - A case report. Indian J Orthop 2005;39:191-2

How to cite this URL:
Thilak J, Varughese J. Arthroscopic fracture fragment removal from the hip - A case report. Indian J Orthop [serial online] 2005 [cited 2020 Jan 21];39:191-2. Available from: http://www.ijoonline.com/text.asp?2005/39/3/191/36741

   Introduction Top


One of the earliest reported hip arthroscopy was by Burman in 1931 and over the years there were very few reports on hip arthroscopy [1],[2] . Since 1980's reports and techniques of clinical application of arthroscopy in the hip joint have continued to appear [3],[4],[5],[6] . The relatively slow development of arthroscopy of the hip is understandable since in the ball and socket joint, the femoral head is deeply recessed in the bony acetabulum and is convex in shape, unlike the more planar surface of the knee.

We present a case of posterior fracture dislocation of the hip with entrapped intra articular fragment following closed reduction, removed with the help of an arthroscope.


   Case Report Top


A 44 year old male manual laborer, sustained posterior fracture dislocation of the left hip following a road traffic accident. He was taken to a local hospital and had closed manipulative reduction of the hip under general anesthesia. Post reduction X-ray showed fracture fragment entrapped in the joint and the patient was referred to our center.

The CT scan and hip radiographs showed a large fragment inside the left hip. He was taken for hip arthroscopic surgery and the fragments were removed. On table there was difficulty in removing the fragment since it was attached to the strong and thick capsular tissue and was lying inverted in to the joint so that the free edge of the fragment was away from the surgeon. The technique involved to remove the fragment was to shave the capsular tissue attached to the fragment and then to flip the fragment so as to grasp the free edge and remove it from the joint.

The removal of the fragment itself did not cause any instability of the hip joint. The patient was discharged on the second post op day on axillary crutches with toe touch down weight bearing for a period of three weeks. Full weight bearing was allowed after three weeks and patient went back to his work in two months period.


   Discussion Top


Volumetric distension of the hip joint is less than the knee, and the fibrocapsular and muscular envelope is thicker. In addition, the relative proximity of the sciatic nerve, lateral femoral cutaneous nerve, and the femoral neurovascular structures place these structures at some risk. Eriksson and co-workers recognized and measured hip capsule distension and distraction forces necessary to allow adequate visualization of the femur and the acetabulum[3] . Johnson and colleagues explained techniques of needle positioning, anatomic landmarks, and cannula placement, and Glick and colleagues described lateral decubitus positioning and peritrochanteric portal placement [4],[5] . Refinement of arthroscopy equipment and instruments specifically for the hip joint has led to relative safe surgery of the hip joint. Currently the indications for hip arthroscopy include removal of loose bodies, synovial biopsy, subtotal synovectomy, and management of labral tears, synovial chondromatosis, osteochondritis dissecans, chondral lesions, or staging of chondral lesions, and the treatment of pyarthrosis. In addition, patients with long-standing, unresolved hip joint pain and positive physical findings may benefit from arthroscopic evaluation [6],[7],[8],[9],[10],[11],[12] .

Hip arthroscopy has tremendously increased our evaluation and therapeutic intervention of hip joint pathology. One of the classical indications of hip arthroscopy is intra articular loose body or fracture fragment removal. The extraction of inverted acetabular fracture fragment with strong and thick capsular attachment requires flipping out of the fragment so as to grasp it firmly and then to cut the soft tissue attached to it. The morbidity following the open arthrotomy to extract the fragments in the joint is avoided with the hip arthroscopic technique. Probably with further improvement in instrumentation and technique, the hip arthroscopy will become more common and easier like knee arthroscopy.

 
   References Top

1.Burman M. Arthroscopy or the direct visualization of joints. J Bone Joint Surg. 1931;4:669-695.  Back to cited text no. 1    
2. Gross r. Arthroscopy in hip disorders in children. Orthop Rev. 1977;6:43­49.  Back to cited text no. 2    
3. Eriksson E, Arvidsson I, Arvidsson H. Diagnostic and operative arthroscopy of the hip. Orthopedics. 1986;9:169-176.  Back to cited text no. 3    
4. Johnson L. Arthroscopic surgery principles and practice. St Louis, CV Mosby; 1986.  Back to cited text no. 4    
5. Glick JM, Sampson TG, Gordon RB, Behr JT, Schmidt E. Hip arthroscopy by the lateral approach. Arthroscopy. 1987;3:4-12.  Back to cited text no. 5    
6. Edwards DJ, Lomas D, Villar RN. Diagnosis of the painful hip by magnetic resonance imaging and arthroscopy. J Bone Joint Surg (Br). 1995;77:374-376.  Back to cited text no. 6    
7. Fitzgerald RH Jr. Acetabular labrum tears: diagnosis and treatment. Clin Orthop. 1995;311:60-68.  Back to cited text no. 7    
8. Frich LH, Lauritzen J, Juhl M. Arthroscopy in diagnosis and treat­ment of hip disorders. Orthopedics. 1989;12:389-392.  Back to cited text no. 8    
9. Hawkins RB. Arthroscopy of the hip. Clin Orthop. 1989;249:44-47.  Back to cited text no. 9    
10. Ide T, Akamatsu N, Nakajima I. Arthroscopic surgery of the hip joint. Arthroscopy. 1991;7:204-211.  Back to cited text no. 10    
11. Ikeda T, Awaya G, Suzuki S, Okada Y, Tada H. Torn acetabular labrum in young patients: arthroscopic diagnosis and management. J Bone Joint Surg (Br). 1988;70:13-16.  Back to cited text no. 11    
12. McCarthy JC, Busconi B. The role of hip arthroscopy in the diagnosis and treatment of hip disease. Orthopedics. 1995;18:753-756.  Back to cited text no. 12    

Top
Correspondence Address:
Jai Thilak
Division of Arthroscopy & Knee Surgery, Amrita Institute of Medical Sciences, Kochi -682026, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.36741

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    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]

This article has been cited by
1 Arthroscopic removal of intraarticular fracture fragment after fracture dislocation of hip
B. Hari Krishnan,G.R. Joshi,Akshay Pushkar
Medical Journal Armed Forces India. 2014;
[Pubmed] | [DOI]



 

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    Introduction
    Case Report
    Discussion
    References
    Article Figures
 

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