Background: Contact between the acetabular labrum and articular cartilage of the femoral head creates a suction seal that helps maintain stability of the femoral head in the acetabulum. A femoral osteochodroplasty may occasionally extend proximally into the femoral head, diminishing the articular surface area available for sealing contact. Purpose: To determine whether proximal overresection decreases the rotational and distractive stability of the hip joint. Study Design: Controlled laboratory study. Methods: Six hemipelvises in the following conditions were tested: intact, T-capsulotomy, osteochondroplasty to the physeal scar, and 5- and 10-mm proximal extension. The pelvis was secured to a metal plate, and the femur was potted and attached to a multiaxial hip jig. Specimens were axially distracted using a load from 0 to 150 N. For rotational stability testing, 5 N·m of internal and external torque was applied. Both tests were performed at different angles of flexion (0°, 15°, 30°, 60°, 90°). Displacement and rotation were recorded using a 3-dimensional motion tracking system. Results: The T-capsulotomy decreased the distractive stability of the hip joint. A femoral osteochondroplasty up to the physeal scar did not seem to affect the distractive stability. However, a proximal extension of the resection by 5 and 10 mm increased axial instability at every angle of flexion tested, with the greatest increase observed at larger angles of flexion ( P < .01). External rotation increased significantly after T-capsulotomy in smaller angles of flexion (0°, P = .01; 15°, P = .01; 30°, P = .03). Femoral osteochondroplasty did not create further external rotational instability, except when the resection was extended 10 mm proximally and the hip was in 90° of flexion ( P = .04). Conclusion: This cadaveric study demonstrated that proximal extension of osteochondroplasty into the femoral head compromises the distractive stability of the hip joint but does not affect hip rotational stability. Clinical Relevance: Clinically, this study highlights the importance of accuracy when performing femoral osteochondroplasty to minimize proximal extension that may increase iatrogenic instability of the hip joint.

Clinically significant malrotation is one of the common complications following intramedullary treatment of femoral shaft fractures. We provide our experience revising an acutely malrotated femoral shaft fracture treated by intramedullary nail fixation. Following clinical examination, radiographic evaluation must include computed tomography scan for evaluation of femoral torsion. Derotation should be pursued after discussion of risks and benefits with the patient, if the malrotation exceeds 15 degrees in comparison with the uninjured limb. Revision surgery must include careful intraoperative clinical examination, as well as bilateral fluoroscopic imaging to confirm improved total femoral neck version. Our preferred technique includes proximal and distal Schanz pins in parallel, which can be used as “joysticks” for performing derotation as well as a measurement tool to evaluate the adjustment angle. A sterile goniometer is required to confirm that adequate derotation has been obtained, before replacing distal interlock screws. Confirmatory imaging and examination is then performed as a second check before waking the patient.

Objectives: Hip microinstability is an increasingly recognized source of hip pain and disability. Femoral osteochondroplasty is usually performed with direct visualization through an arthroscope, assisted with repeated fluoroscopic imaging. However, a two-dimensional representation of a three-dimensional structure is misleading and may compromise the precision of the planned osteochondroplasty. The resection can occasionally extend proximally into the Femoral Head diminishing the articular surface area available for suction seal. The purpose of this study was to determine whether proximal over-resection decreases the rotational and distractive stability of the hip joint. Methods: Six hemi-pelvises were repeatedly tested in the following conditions: (a) intact, (b) T-capsulotomy, (c) Osteochondroplasty to the physeal scar, followed by (d) 5mm and (e) 10mm proximal extension. The pelvis was secured to a metal plate and the femur was potted and attached to a multi-axial hip jig. Specimens were axially distracted with a load from 0-150N followed by 5Nm of internal and external torque at 0o, 15o, 30o, 60o, 90o of flexion. Displacement/rotation was recorded using a 3D motion tracking system. Repeated measures ANOVA was used with significance set at p<0.05. Results: Proximal extension of the resection by 5mm and 10mm increased axial instability at every angle of flexion tested, with the greatest increase observed at higher angles of flexion,p<0.05. T-capsulotomy alone increased both internal and external rotation at all angles of flexion, p<0.05. Subsequent resection and extension of the resection did not significantly increase rotational instability compared to the capsulotomy state. Conclusion: Extending the osteochondroplasty proximally into the femoral head compromises the distractive stability of the hip joint, but doesn’t not effect hip rotational stability. Clinically, this highlights the importance of accuracy when performing femoral osteochondroplasty to minimize proximal extension that may increase iatrogenic instability of the hip joint, leading to reduced post-operative outcomes.

Objectives: Hip microinstability is an increasingly recognized source of hip pain and disability. Femoral osteochondroplasty is usually performed with direct visualization through the arthroscope, assisted with repeated fluoroscopic view for orientation and feedback. However, a two-dimensional representation of a three dimensional structure can be misleading compromising the precision of the planned osteochondroplasty. Sometimes the resection can extend proximally into the Femoral Head (FH) diminishing the surface area of the articular cartilage available to be in contact with the labrum, in order to create the suction effect (suction seal) that maintains the stability of the femoral head in the acetabulum. The purpose of the study is to evaluate the role of proximal over-resection of femoral osteochondroplasty in the rotational and distractive stability of the hip joint. We hypothesis that proximal over resection will result in decrease stability, specially at higher degrees of flexion and internal rotation where the contact between labrum and articular cartilage will be lost, and breaking the suction seal. Methods: Six hemi-pelvises were repeatedly tested in the following five conditions: (a) intact, (b) T-capsulotomy, (c) Osteochondroplasty to the level of the physeal scar, followed by a (d) 5mm and (e) 10mm proximal extension of the resection. The pelvis was secured to a metal plate and the distal portion of the femur was potted and attached to a multi-axial hip jig. (Fig.1) Specimens were axially distracted with a load from 0-150N followed by 5Nm of internal and external torque at 0 o, 15 o, 30 o, 60 o, 90o of flexion while the resultant displacement/rotation was recorded using a 3D motion tracking system. Repeated measures ANOVA was used with statistical significance set at p<0.05. Results: Proximal extension of the resection by 5mm and 10mm increased axial instability (decreased force required for hip distraction) at every angle of flexion tested, with the greatest increase observed at higher angles of flexion (60 deg and 90 deg), p<0.05. T-capsulotomy alone increased both internal and external rotation at all angles of flexion, p<0.05. (Fig. 2) Subsequent resection and extension of the resection did not significantly increase rotational instability compared to the capsulotomy state. Conclusion: Extending the osteochondroplasty proximally into the femoral head compromised the distractive stability of the hip joint. It is important to be precise when performing femoral osteochondroplasty to minimize proximal extension that can lead to iatrogenic instability of the hip joint and poor postoperative outcomes. [Figure: see text][Figure: see text]

Flexor tendon sheath hematoma warrants consideration in the differential diagnosis of patients presenting with the signs and symptoms of acute septic flexor tenosynovitis.