Traumatic hip dislocation in children.

The aim of this study was to evaluate the outcomes of reduction in the treatment of traumatic posterior hip dislocation in children. Data of 22 pediatric patients (22 hips) with traumatic hip dislocation from January 1995 to December 2007 were analyzed. The clinical evaluation focused on symptoms, physical findings, and range of motion. Radiographs identified the type of hip dislocation. The hip dislocation classification was based on Thompson and Epstein. The reduction procedure was performed according to three variants: variant 1, closed reduction; variant 2, release of the adductor longus, lengthening of the psoas tendon, and insertion of a Kirschner wire through the femoral head into the acetabulum; and variant 3, removal of the soft-tissue interposition of the hip. After reduction, radiography was used to determine whether the hip is concentric and to check whether any other injuries might have been caused after manipulation. There were six females (27.3%) and 16 males (72.7%) in this study. All had type I posterior dislocation of the hip. The ages of the patients at diagnosis ranged from 3 years, 2 months to 9 years, 10 months. The reduction procedure was performed according to variant 1 in 16, variant 2 in five, and variant 3 in one. We attained excellent results in eight hips (36.4%), good results in seven hips (31.8%), fair results in four hips (18.2%), and poor results in three hips (13.6%). There was avascular necrosis in three hips (13.6%), coxa magna in two hips (9.1%), deficient limb of 2 cm in two hips (9.1%), and a limp in two hips (9.1%). The hip scores were 82.4 points on average (range 62-100). Children with traumatic hip dislocation should undergo reduction as soon as possible. If the interval from injury to reduction exceeds 3 weeks, we suggest that the surgeon release the adductor longus, lengthen the psoas tendon, and insert a Kirschner wire. This simple and safe surgical procedure results in marked improvement in hip function and prevents complications later.

Ilial anterior rotation hypermobility in a female collegiate tennis player.

BACKGROUND AND PURPOSE: This case report describes the examination, evaluation, and intervention by a physical therapist for a female collegiate tennis player with a right ilial anterior rotation hypermobility. CASE DESCRIPTION: The patient was a 21-year-old, female collegiate tennis player who developed a right anterior ilial rotation hypermobility as a result of her tennis stroke. Functional limitations were related to sitting, squatting, gait, and playing tennis. Treatment interventions consisted of massage, joint manipulation, stretching, stabilization exercises, sport-specific exercises and modification of tennis stroke, proprioceptive taping, and the use of a sacroiliac belt. OUTCOMES: After 26 weeks (33 treatments), tissue tenderness of the sacroiliac joint region was normalized, pelvic/trunk and lower-extremity mobility and flexibility were restored, sacroiliac symmetry and stability were regained, and the patient achieved her goal of returning to competitive tennis at the collegiate level. DISCUSSION: The patient's right ilial anterior rotation hypermobility was directly related to the mechanics of her tennis stroke. Her outcomes suggest that rehabilitation should focus on the entire abdomino-sacro-pelvic-hip complex, addressing articular, neural, and muscular inhibitions and deficiencies.

Unresolving hip tendonitis leads to discovery of malignant tumor.

OBJECTIVE: To discuss a case of malignant bone tumor in the left hip of a patient who sought treatment following a tennis injury. CLINICAL FEATURES: A 27-year-old male patient visited a chiropractic clinic 6 months after a twisting injury to his left hip which occurred while playing tennis. His pain had remained moderate in intensity and intermittent to frequent in frequency since it originated but became more intense the week prior to his visit. INTERVENTION AND OUTCOME: The patient was diagnosed with a tendonitis/bursitis and received 3 weeks of treatment. Care consisted of various forms of passive modalities to reduce pain and inflammation, as well as hip mobilization and tissue stretching. Plain film examination was then performed, due to lack of progress, and revealed a possible chondroblastoma of the femoral head. The patient was referred to his primary care physician (PCP) for follow-up imaging. Surgical resection of the lesion occurred approximately 2 months later. Biopsy of the resected cells confirmed a new diagnosis of clear cell chondrosarcoma. A computed tomography (CT) scan of the chest was performed to rule out metastasis to the lungs. Regular follow-up care and imaging continued and revealed, 9 months following, that the femoral head lesion had returned and hip replacement surgery would be needed. CONCLUSION: Tendonitis, bursitis, and sprains commonly occur following sports-related trauma to the appendicular skeleton. A conservative trial of care should be performed on suspected soft tissue injuries. However, when lack of improvement occurs within the first month, further examination, special studies, or referral are warranted to ensure a proper diagnosis and to rule out a pathological condition.