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: There are several complications associated with spinal cord injury. The authors propose to evaluate the complications developed during hospitalization of tetraplegic patients treated in our institution.

Materials and Methods: The clinical and imaging records of 20 tetraplegic patients operated between 1995 and 2007 were evaluated (14 men and 6 women; mean age 31.5 years; 16 submitted to surgery using anterior cervical approach, 4 using posterior approach; 8 did steroids protocol during 24h and 12 during 48h; 9 patients were operated less than 48h after trauma and 11 patients after).

Results: Mean hospitalization time was 47.4 days (men 48.9 d, women 23.4 d; anterior approach 50.25 d, posterior approach 39 d; corticosteroids during 24h 34.3 d, 55.3 d in those who did 48h; time until surgery < 48h 43.1 d, > 48h 54.5 d). 100% of patients developed respiratory tract infections.

56.3% of patients developed urinary tract infections (33% in patients doing corticosteroids during 24h, 70% in those who did 48h)

Mean duration of mechanic ventilation was 20.3 days (anterior approach 19.3 d, posterior approach 19.8 d; steroids during 24h 16.7 d, steroids during 48h 21 d; time until surgery < 48h 13.6 d, > 48h 23 d)

In 37.5% of patients a traqueostomy was performed (41.7% in patients submitted to anterior approach, 25% in posterior approach; 16.7% in patients doing steroids during 24h, 50% in those who did 48h; time until surgery < 48h 28.6%, > 48h 50%)

Discussion: This patients are associated with long hospitalization and mechanic ventilation periods. Respiratory tract infection was the most frequent complication. The surgical approach had no influence on mechanic ventilation periods. Those submitted to anterior approach had longer hospitalization periods and higher incidence of traqueostomy. Patients who did corticosteroids during 48h had higher incidence of urinary tract infections and traqueostomy, and longer mechanic ventilation periods. Those operated less than 48h after trauma had shorter hospitalization and mechanic ventilation periods and traqueostomy procedure.

Conclusion: Steroids longer than 24h, anterior cervical approach and time to surgery > 48h tend to be associated with higher complication rates