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Acetabular "Fleck" Sign: Outcomes of Surgical Repair.

Stephanie Chen¹, Kirsten Tulchin-Francis², Dan Gaines³

¹Campbell Clinic, Memphis, TN.

Journal of Pediatric Orthopedics

|March 8, 2024

Summary

Open labral repair using surgical hip dislocation (SHD) in pediatric patients with an acetabular "fleck" sign following hip dislocation shows excellent outcomes and no avascular necrosis (AVN). This procedure restores hip anatomy and stability for improved patient function.

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Published on: November 8, 2024

Area of Science:

Pediatric Orthopedics
Trauma Surgery
Hip Preservation

Background:

Traumatic posterior hip dislocations in children often require closed reduction.
An acetabular "fleck" sign indicates significant hip pathology, even after successful reduction.
This sign suggests an osteochondral avulsion of the posterior/superior labrum.

Purpose of the Study:

To evaluate the outcomes of open labral repair via surgical hip dislocation (SHD).
To assess patients with an acetabular "fleck" sign and traumatic hip dislocation/subluxation.
To determine the efficacy of SHD in restoring hip anatomy and stability.

Main Methods:

Retrospective review of pediatric patients (2008-2022) with traumatic hip dislocation/subluxation and an acetabular "fleck" sign.
Patients underwent open labral repair through SHD.
Clinical outcomes were measured using the modified Harris hip score (mHHS); complications like heterotopic ossification (HO) and avascular necrosis (AVN) were assessed.

Main Results:

Twenty-nine pediatric patients (average age 13.0 years) were included.
All patients returned to their preinjury activity level.
Excellent mHHS scores were reported (94.9±7.4); no cases of AVN occurred, though one patient developed post-traumatic dysplasia.

Conclusions:

The acetabular "fleck" sign signifies an osteochondral avulsion requiring specific surgical management.
SHD with open labral repair in this cohort yields excellent clinical outcomes.
Restoring native hip anatomy and stability through this procedure is crucial for favorable results.