Hosptial For Special Surgery: What's the Diagnosis - Case 45

Findings AP radiograph demonstrates a widening along the medial aspect of the left hip joint particularly when compared to the contralateral side. Coronal IR images demonstrate a moderate sized joint effusion and a moderate amount of edema seen extending into particularly the posterior soft tissues. Surface sagittal, coronal, and axial images of the left hip demonstrate a subtle fracture of the posterior wall (lip) of the acetabulum and a tear of the posterior labrum leading to a bucket handle displacement of the posterior labrum and transverse acetabular ligament into the joint space. Disruption is seen of the posterior joint capsule with a lower grade injury sustained to the iliofemoral ligament.

Displaced chondral fragment is also identified.

What’s the Diagnosis – Case 45

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Diagnosis Posterior hip subluxation with acetabular fracture and displaced labrum

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Discussion Posterior translation events of the hip are typically associated with high speed motor vehicle accidents where the flexed knee impacts the dashboard with a flexed hip driving the femoral head posteriorly. This can yield fractures of the posterior acetabulum, femoral head, and potential injury to the sciatic nerve.

Gaining increased recognition is that athletes may sustain posterior subluxations either related to a flexed knee impacting the ground with a flexed hip, blow from behind while on all four limbs, or impaction of the foot on the ground with an extended leg and locked knee transmitting force posteriorly to the hip.

Posterior translation events of the hip are typically associated with high speed motor vehicle accidents where the flexed knee impacts the dashboard with a flexed hip driving the femoral head posteriorly. This can yield fractures of the posterior acetabulum, femoral head, and potential injury to the sciatic nerve.

Gaining increased recognition is that athletes may sustain posterior subluxations either related to a flexed knee impacting the ground with a flexed hip, blow from behind while on all four limbs, or impaction of the foot on the ground with an extended leg and locked knee transmitting force posteriorly to the hip.

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Resources Diagnosis and management of traumatic and atraumatic hip instability in the athletic patient. Shindle MK, Ranawat AS, Kelly BT. Clin Sports Med. 2006 Apr;25(2):309-26, ix-x. http://www.wheelessonline.com/ortho/posterior_frx_dislocations_of_the_hip http://www.learningradiology.com/archives06/COW 195-Posterior hip dislocation/postdislocacorrect.htm

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