Arthroscopic Treatment of Acetabular Rim Fracture after Traumatic Posterior Hip Dislocation: A Case Series Study

Abstract

Objective: To investigate the clinical and radiographic short-term results of arthroscopic treatment for posterior labrum tears with an attached bony fragment after traumatic posterior hip dislocation.Methods: Between July 2014 and May 2019, a consecutive series of nine patients diagnosed with a posterior labrum tear with an attached bony fragment after traumatic posterior hip dislocation were treated by hip arthroscopic techniques. The patients had been injured in traffic accidents (n = 6) or high falls (n = 3). All patients were provided primary treatment at the emergency department of our institution, and then were transferred to our department for arthroscopy. Demographic data (e.g. gender, age, etc), intraoperative findings, the preoperative and postoperative multiple clinical scores and radiological results were subsequently assessed. Visual analogue scale for pain (VAS) and modified Harris hip scores (mHHSs) were measured and compared before surgery, and at the last follow-up.Results: A total of nine patients were enrolled, all of them were male, with a mean age at surgery of 32.2 AE 5.6 years (range, 22-65 years). The patients were followed-up for an average of 26.5 AE 4.1 (range, 24 to 50 years). During the arthroscopic surgery, all patients had labral tears with posterior acetabular rim fracture. All patients had loose osteochondral fragments. Five had partial or complete tears of ligamentum teres. Two patients had osteochondral damage. Two had capsular rupture. Postoperative X-ray films and three dimension computed tomography (3D-CT) showed satisfactory reduction of posterior acetabular wall fractures. The mHHS before surgery and at 1 year and 2 years after surgery were 51.8 AE 4.3, 81.8 AE 2.0 and 87.5 AE 1.9 respectively; VAS scores were 5.6 AE 0.5, 1.3 AE 0.3 and 0.7 AE 0.3 respectively. As compared with the condition before surgery, there was a significant improvement in the mHHS and VAS scores at 1 year and 2 years after surgery (P < 0.01). There was no significant improvement in the mHHS and VAS scores between 1 year and 2 years after surgery (P < 0.05). At the final follow-up, all patients had regained full range of motion (ROM) and were satisfied with the results. None of the patients showed signs of heterotopic ossification, avascular necrosis or progression of osteoarthritis of the hip joint. Conclusion:Traumatic dislocation is accompanied by a variety of intra-articular hip joint pathologies. Managing posterior acetabular rim fracture after traumatic posterior hip dislocation using arthroscopic reduction and fixation with anchors is a safe and minimally invasive option and delays the progression of traumatic osteoarthritis.

Surgical Technique: Arthroscopic Reduction and Fixation of Partial Posterior Wall Acetabular Fractures

“…Zhong et al. 14 reported on a series of 9 patients with a diagnosis of a posterior labral tear accompanied by an attached bony fragment after traumatic posterior hip dislocation. These cases were addressed by hip arthroscopic techniques, using suture anchor fixation for the fragment without the use of screws.…”

“…All cases achieved uneventful union, with a mean modified Harris Hip Score of 81.8 (standard deviation, 2) at the 1-year postoperative mark. 14 Hwang et al. 17 recently published a case series of 13 patients who received arthroscopic fixation of acetabular posterior wall fractures with cannulated screws, in the lateral decubitus position, addressing this procedure as a good alternative option with good radiographic and clinical outcomes, convenient removal of intra-articular loose bodies, and low complication rates.…”

“… 13 Nonetheless, there exist limited reports in the literature regarding labral fixation of posterior wall fractures, indicating its valuable role in enhancing overall outcomes through meticulous patient selection. 6 , 14 …”

Effect of Vacuum Sealing Drainage on Soft Tissue Injury of Traumatic Fracture and Its Effect on Wound Recovery

“…Fractures that occur after high-energy trauma are usually accompanied by various intra-articular lesions such as ligamentum teres injury, loose body, cartilage injury, and trauma of soft tissue like the lip, which can cause ischemic necrosis, post-traumatic osteoarthritis, and even long-term disability in severe cases [18][19][20]. erefore, for STIs of TFs, it is necessary to use the correct treatment.…”