Spontaneous Healing Of A Bucket-handle Posterior Labral Detachment After Hip Dislocation In A Five-year-old Child: A Case Report
Clement, R. C., Carpenter, D. P., & Cuomo, A. V. (2018). Spontaneous Healing of a Bucket-Handle Posterior Labral Detachment After Hip Dislocation in a Five-Year-Old Child: A Case Report. JBJS case connector, 8(2), e28. https://doi.org/10.2106/JBJS.CC.17.00133
View Original Source →Abstract
CASE: We report the case of a 5-year-old girl who sustained a traumatic hip dislocation and a spontaneous reduction that was complicated by nonconcentric reduction and a large bucket-handle labral detachment. This injury was managed, via an anterior approach, with capsulotomy and reduction of the large interposed labral tear with an attached osteochondral fragment from the posterior aspect of the acetabulum. No additional surgical treatment was employed for the labral tear. CONCLUSION: The patient ultimately demonstrated radiographic healing and an asymptomatic, clinically stable hip. This case illustrates the spontaneous healing of a large posterior labral detachment in a young pediatric patient with a good outcome at 2.5 years after injury.
Case Details
Disease Location
Hip
Personal Characteristics
5-year-old girl
Clinical Characteristics
Admitted after a high-speed motor vehicle collision. She had been unrestrained, and there had been 2 fatalities. Orthopaedic injuries included a right subtrochanteric fem- oral fracture, fractures of the distal aspect of the right tibia and the fibula, fractures of the proximal aspect of the left tibia and the fibula, and several minimally displaced pelvic fractures. A loose body, known as the “fleck” sign5, was also visible in the right acetabulum on computed tomography (CT), with nonconcentric joint reduction, suggesting hip dislocation with spontaneous reduction. All of the fractures were closed. The bilateral tibial fractures were managed with long-leg splints, and the right femoral fracture and pelvic injuries were managed with 10 lb (4.5 kg) of right-sided traction. On postinjury day 6, she was scheduled for surgical removal of the loose bodies and the interposed tissue from the right hip was planned for postinjury day 16. While performing the capsulotomy, a bucket-handle tear of the posterior aspect of the labrum was found entrapped in the joint, with the posterior labral aspect draped over the anterior aspect of the femoral head with an attached osteochondral fragment that had been avulsed from the posterior aspect of the acetabulum. The labrum was left reduced but detached
Remission Characteristics
Repeat MRI of the right hip was obtained on postinjury day 71, revealed that the previously noted fluid collection had resolved, and the labrum appeared to be healed with minimal abnormality
Treatment & Mechanisms
Clinical Treatment
Long-leg splints, traction, capsulotomy