Abstracts Posters SICOT-SOF meeting Gothenburg 2010 _2_

Poster
Topic: Sports Medicine - Hip
Abstract number: 23217
ARTHROSCOPIC HIP OSTEOSYNTHESIS
Dean MATSUDA
Kaiser Permanente, Los Angeles, California (UNITED STATES)
Our presentation highlights techniques developed and lessons learned from two
interesting cases of femoral head fractures, one associated with posterior hip
dislocation and previously asymptomatic femoroacetabular impingement, the other a
very rare isolated fracture. In one case example, a large suprafoveal osteochondral
fracture was arthroscopically reduced by use of crossover techniques gained from
experience performing arthroscopic femoroacetabular impingement surgery. An
innovative “chopstick” maneuver was used to derotate the mobilized osteochondral
fragment into anatomic position, followed by arthroscopic Herbert screw fixation. In
the other case example, a "clamshell" femoral head osteochondral fracture is
described. The clamshell fracture is opened and the largest fragment reduced and
fixated using Acutrak screws in a completely arthroscopic manner. The rationale for
performing acetabular rim reduction in this patient with asymptomatic
femoroacetabular impingement prior to arthroscopic screw fixation in order to
optimize the angle of attack is discussed. Professionally-edited video (upon request)
and 1 and 2 year clinical outcomes are presented showing improvement in pain and
activity restoration as well as radiographic fracture union without osteonecrosis or
osteoarthritis. As hip arthroscopy evolves, the role of arthroscopic surgery in the
traumatized hip may expand beyond diagnostic arthroscopy and foreign/loose body
removal. An anatomic reduction with stable internal fixation permitting early joint
motion trumps the ability to perform outpatient arthroscopic procedures. However, if
the equivalent procedure can indeed be accomplished in a safe and minimally
invasive manner, one can envision a future expansion of the role of hip arthroscopic
surgery in fracture management.
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