Pistol grip deformity of the hip with os acetabuli

Case contributed by Dr Roberto Schubert


Professional hockey player complaining of increasing right hip pain during exercise. Elevation and internal rotation of the hip was painfully limited.

Patient Data

Age: 30 years
Gender: Male

Fig. 1: AP radiograph of the right hip showing a bump (arrow) at the anterosuperior head-neck junction with atypical lateral extension of the epiphyseal line. Also note the presence of an os acetabuli.

Fig. 2: Axial radiograph of the right hip. The deformity at the head-neck-junction (arrow) is rotated outward.

AP and axial radiographs showed joint space narrowing, subchondral sclerosis and small osteophytes at the femoral head and acetabulum. 

MR arthrography (coronal T1-GRE fatsat) showing contrast medium within a small longitudinal tear of the acetabular labrum and slight irregularities of the chondral surface in the anterosuperior joint socket (Fig. 3). Radial MPR of the 3D arthrographic sequence along the anterosuperior head-neck junction with an elevated alpha angle (angle of Nötzli was 63°) indicating femoroacetabular cam impingement.


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Case information

rID: 13802
Published: 18th May 2011
Last edited: 13th Aug 2019
Inclusion in quiz mode: Included

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