Spontaneous Healing Of A Bucket-handle Posterior Labral Detachment After Hip Dislocation In A Five-year-old Child
Clement, R. CARTer MD, MBA; Carpenter, Daniel P. MD; Cuomo, Anna V. MD. 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):p e28, June 2018. | DOI: 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
Right hip joint fracture (among several other injuries) due to high-speed motor vehicle collision
Personal Characteristics
5-year old female
Clinical Characteristics
Bucket-handle tear of posterior aspect of labrum , with 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; gross hip instability with posterior subluxation when abdominalucted <20 degrees or flexed >40 degrees; MRI 2 days after capsulotomy surgery (18 days after accident) showed separation of the posterior aspect of the labrum from the acetabular rim with a large posterior fluid collection
Remission Characteristics
MRI of hop on day 71 after initial injury (55 days after spica cast) showed no fluid collection and healed labrum
Treatment & Mechanisms
Clinical Treatment
10 lb traction; fixation of femur with elastic nails; capsulotomy performed on right hip on day 16 after the injury; tissue was found entrapped in the joint during capsulotomy surgery and interposed tissue was reduced behind the femoral head but labrum was left reduced but detached due to inability to access; lower extremity was placed in a bilateral long-leg spica cast for hip instability; discharged to rehabilitation center 3 days post-capsulotomy surgery; transferred to abdominaluction brace on day 71 post-injury
Non-Clinical Treatment
None reported stated