Introduction: Hip Surgical Dislocation (SHD) according the technique described by Ganz et al. is a safe and powerful tool to access intra-articular hip pathology in adults. Some indications may also arise in younger patients to correct slipped capital femoral epiphysis or femoral neck deformities

Materials and Methods: From 2004 to 2008 we have selected 45 patients on whom the procedure was done to treat femoroacetabular impingement (FAI). The average follow up time is 3 years, and patient mean age 26 years. The indications for SHD were:

mixed FAI in 26 cases,

42 hips where graded as Tönnis 0 and 2 as Tönnis 1. All patients where evaluated according to the non arthritic hip score (NAHS – McCarthy et all) before and after the surgery at 3, 6, 12, 24 and 36 months. Osyrix^® software was used to measure radiographic parameters. The numeric variables where treated using SPSS for windows (paired t student test).

Surgical Technique: In all 45 cases we did SHD, acetabular and/or femoral head neck junction trimming and labrum refixation. In half cases an anterior step trochanteric osteotomy was done and in 7 cases additional relative neck lengthening was performed.

Results: The average alfa angle measured in the standard crosstable view x ray was 72° before surgery and 36° after surgery (p=0,0001). The NAHS before surgery was 40,8 average: 9,71 – pain; 6,9 – symptoms; 9 – function and 6,9 – activities and after surgery 76,38 average (p= 0,0001) 17,5 – pain (p= 0,0001); 12,9 – symptoms (p= 0,0001); 16 - function (p= 0,0001) and 14,9 - activities (p= 0,0001). All patients improved motion, specially flexion, internal rotation (p= 0,0001). The results did not differ significantly in the patients who had a trochanteric anterior step osteotomy. One patient had a total hip replacement for ongoing osteoartrithis

We had no avascular necrosis so far and no neurovascular damage. Trochanteric screw removal was done in 3 cases for local irritation. We had 2 capsule adhesions, released shortly after using arthroscopy.

Conclusions: SHD is a demanding technique with full access to femoral head and acetabular deformities as well as cartilage or labral tears. It can be done safely with a low complication rate. The best results are achieved in young patients without degenerative cartilage and significant labrum changes. Hip degenerative changes contraindicates this procedure. Modification of trochanteric osteotomy does not seem to influence results

Introduction – Elbow dislocation in children is a rare lesion and most of the times is associated with a fracture of the medial epicondyle. When there is a fracture of the radial neck it is even more rare and usually represents a major instability with large soft tissue disruption.

Methods – Between 1984 and 2003, 56 patients with unilateral elbow dislocations were identified ranging from 4 to15 years of age. In 8 patients a radial neck fracture was associated and in two there was a radio ulnar translocation . All these patients were treated the same way: closed reduction of the fracture dislocation under general anesthesia, evaluation of the instability and fracture fixation by closed means (Metaizeau technique). No ligamentous reconstruction was performed even in the presence of severe instability after bone reconstruction. A plaster was applied for two weeks followed by active mobilization.

Results – All fractures healed with no complications. All patients except one regained full range of motion. The patient with a loss of extension (20°) complaints of pain on the lateral side during sports activity and has a minor instability test positive for the lateral collateral ligament.

Discussion – This is a rare lesion in children not well documented in the literature. In the adult population there is an emphasis on the necessity of a repair of the soft-tissue structures as an integral part of the surgical strategy for elbow dislocation that require operative treatment (Mckee et al. J Shoulder Elbow Surg. 2003 Jul–Aug;12(4):391–6). In this small series we found no major instability in a long follow-up study even without reconstruction of the soft-tissues.

Conclusion – We concluded that in this particular type of lesion, a close anatomical reduction of the articular surfaces with restoration of the normal relationship around the elbow was fundamental to restore elbow stability with no need for soft-tissue reconstruction