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Marín-Pena O, Ayeni OR, Tey-Pons M, Mas-Martinez J, Dantas P, Khanduja V. The case of 'A Rhino Horn': case report and proposal for modification to the Hetsroni and Kelly classification. J Hip Preserv Surg 2021; 8:i51-i59. [PMID: 34178372 PMCID: PMC8221379 DOI: 10.1093/jhps/hnab020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/13/2022] Open
Abstract
Subspine impingement syndrome by definition involves a prominent antero-inferior iliac spine (AIIS) which can lead to impingement on the femoral neck thereby causing symptoms. We present the case of a 22-year-old semi-professional athlete who presented with a Type III AIIS morphology leading to subspine impingement syndrome and was managed via a mini open anterior approach. Radiological examination revealed a fairly prominent left AIIS resembling the 'horn of a rhino' extending to the trochanteric region anteriorly. A mini-anterior surgical approach was utilized for the resection of the 'rhino horn' and the rectus femoris was reattached. The patient remained asymptomatic at the one-year follow-up and had resumed weightlifting. Following this case, we propose a new classification of the type III AIIS morphology in view of the clinical presentation. The AIIS type III-Standard represents an extension from the acetabular rim to less than 1 cm (type III-S) and type III-Large, with an extension from the acetabular rim beyond 1 cm (type III-L). The type III-L will further be divided into two groups based on its relation to the ilium, type III-Lr ('rib shape') and type III-Lrh ('rhino horn').
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Affiliation(s)
- Oliver Marín-Pena
- Orthopedic and Traumatology Department, Hospital Universitario Infanta Leonor, Gran via del Este 80. 28031, Madrid, Spain
- Grupo Ibérico de Cirugía de Preservación de Cadera (GIPCA), José Abascal, 44 – 1º 28003, Madrid, Spain
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St West, 4E15, Hamilton, ON L8N 3Z5, Canada
| | - Marc Tey-Pons
- Grupo Ibérico de Cirugía de Preservación de Cadera (GIPCA), José Abascal, 44 – 1º 28003, Madrid, Spain
- Hospital del Mar y la Esperanza. Hip Unit, iMove Traumatología, Clínica Mi Tres Torres, Passeig Marítim 25-29 Barcelona 08003, Spain
| | - Jesús Mas-Martinez
- Grupo Ibérico de Cirugía de Preservación de Cadera (GIPCA), José Abascal, 44 – 1º 28003, Madrid, Spain
- HLA Clinica Vistahermosa, Hip Unit, Department of Orthopedic Surgery, Av de Denia 76, 03016, Alicante, Spain
| | - Pedro Dantas
- Grupo Ibérico de Cirugía de Preservación de Cadera (GIPCA), José Abascal, 44 – 1º 28003, Madrid, Spain
- Centro Hospitalar Lisboa Central. Hospital CUF Descobertas. Alameda Santo António dos Capuchos, 1169-050 Lisboa, Portugal
| | - Vikas Khanduja
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
- University of Cambridge, Trinity Ln, Cambridge CB2 1TN, UK
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