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Abstract & Commentary
Synopsis: The study reports a series of 8 American football players with acute traumatic posterior hip subluxation diagnosed with obturator oblique Judet views. Early hip joint aspiration should be considered in this patient population.
Source: Moorman CT III. Traumatic posterior hip subluxation in American football. J Bone Joint Surg. 2003;85-A(7): 1190-1196.
What really happened to end Bo Jackson’s stellar football career? Like other lesser-known football players, he suffered a hip subluxation that eventually lead to devastating avascular necrosis of his hip. Moorman presented a series of 8 American football players who sustained a traumatic posterior hip subluxation. They characterized the mechanism of injury, pathoanatomy, diagnostic features, and recommended treatment for football players with this injury.
In 6 of the 8 players studied, the mechanism of injury was a fall on a flexed knee with the hip adducted and flexed. None of the players was able to return to play following the injury. Radiographs (obturator oblique Judet views) demonstrated a posterior acetabular lip fracture in all 8 patients. Magnetic resonance imaging (done in 7 of the 8 players) demonstrated a hemorrhagic joint effusion and bone marrow edema in the area of the posterior acetabular lip fracture, as well as disruption of the iliofemoral ligament (Y-ligament of Bigelow). Patients were treated with crutches and toe-touch weight bearing only for 6 weeks. Two patients with excruciating pain on presentation to the emergency room were treated with hip joint aspiration. Despite the relatively low energy trauma involved, 2 patients went on to develop osteonecrosis. Neither of the 2 patients with hip joint aspiration developed osteonecrosis. Moorman believes that intracapsular tamponade may have played a role in this process, as well as leading to the development of post-traumatic chondrolysis, which also occurred in 1 of these players.
Comment by Mark D. Miller, MD
Although a case series by its very nature precludes unambiguous establishment of cause and effect, it is obvious that American football players who sustain a seemingly minor hip "sprain" may instead have a much more serious injury. Obturator oblique (Judet) views must be obtained in patients with significant hip injuries because routine plain films will be normal. Early hip aspiration should be encouraged to reduce the risk of intracapsular tamponade. It is unclear why the disruption of the iliofemoral ligament (part of the hip capsule) did not result in decompression of the capsule, but, as Moorman suggests, perhaps part or most of the capsule remained intact. Hip joint aspiration in this setting is similar to what Dr. Mark Swiontkowski recommends in patients with intracapsular hip fractures, and it makes good sense. Protected weight bearing is also a reasonable treatment recommendation. If nothing else, this paper should serve to heighten our awareness of this injury in American football players.
Dr. Miller, Associate Professor, UVA Health System, Department of Orthopaedic Surgery, Charlottesville, VA, is Associate Editor of Sports Medicine Reports.