Hip Instability Treatment | Posterior and Anterior Hip Instability | Posterior Rim Fracture Hip скачать в хорошем качестве

Hip Instability Treatment | Posterior and Anterior Hip Instability | Posterior Rim Fracture Hip

At the 2015 Vail Hip Symposium J.W. Thomas Byrd, MD discusses traumatic hip instability treatment. Sports related hip instability is different than vehicular trauma, because these injuries are usually low velocity instead of high velocity. Posterior hip instability comes from macrotrauma, and the reason physicians see these injuries is because of the common mechanism of injury in contact and collision sports. Anterior hip instability comes from microtrauma, because there are factors that create vulnerability for hip instability. One of the most common causes for vulnerable hip instability is an association with dysplasia and activities that demand supraphysiologic motion (gymnastics, dance, figure skating). Another cause is an increased McKibbon's index and diminished CE angle and increased neck shaft angle. As the head team physician for the Tennessee Titans, in 2008, Dr. Byrd presented a study on NFL experience on posterior hip instability. The study found that the diagnosis was not necessarily that obvious - symptoms were not that debilitating - some athletes continued to play or tried to play after significant subluxation episodes. A lot of the injuries reported were non-contact injuries. Posterior rim fractures were not uncommon, but did not adversely affect the outcome. These rim fractures are easily over looked, because the x-ray machines used at the NFL stadiums were not high quality, and even with high quality imaging, these injuries are not an initial cause for concern for asymptomatic patients. MRI's will often times mis-interpret a posterior rim fracture as a labral tear, because this bone is avascular, so there is no bony edema that you would expect to see with a fracture. The study recommended a treatment strategy for posterior rim fractures that included an early arthroscopic intervention only for non-concentric reduction or entrapped fragments. Generally, we would consider arthroscopy after the athlete was through with the acute phase of the injury, which was generally 3 months. In a lot of these cases, the subsequent evidence found subchondral edema in the femoral head. Reasonable expectation for return to football is 8-10 weeks. Most of these treatments do well, but some are destined to do poorly, so it obligates the physician to provide a thoughtful treatment strategy. Dr. Byrd continues by discussing his study "Is Posterior Hip Instability Associated with Cam and Pincer Deformity?". This study found that 90% of athletes with posterior rim fractures returned to their previous sport. Dr. Byrd shows a clip of an NFL player getting hit directly and sustains a hip injury and an NFL player that sustains a hip injury from non-contact, which is probably a more common mechanism. Dr. Byrd shows an illustrative example of a D1 collegiate defensive end who has had 2 subluxation episodes in his left hip, a year apart. He had a significant posterior wall sign, CAM morphology on his MRI he had a posterior and anterior labral tear. On his CT images he has acetabular retroversion. In this case, Dr. Byrd repaired the posterior and anterior labral tears just like you would when performing a Bankart repair in the shoulder. The CAM lesion is corrected and he returned to collegiate football successfully. In the next example, Dr. Byrd shows a 25 year old elite level female athlete who became symptomatic with a right labral tear. She has a mild CAM lesion. Dr. Byrd corrected the hip injury and then 7 months later came back with hip dislocation. Dr. Byrd and his team determined there were 6 multifactorial causes. Dr. Byrd and his team were able correct the torn capsular and connected her with a trainer that increased her strength. In summary, hip instability can occur on many different levels. There is a spectrum of physiologic laxity and pathologial instability. There are bony and soft tissue contributions to stability and static vs. dynamic stabilizers.