Clinical Outcomes and Associated Pathologies Following Pediatric Traumatic Hip Dislocations: A Systematic Review of the Literature

Abstract

Introduction: Pediatric traumatic hip dislocations are a rare condition that can have devastating short and/or long-term outcomes and associated pathologies (APs), including associated injuries (AIs) and long-term adverse events (LTAEs), with negative long-term sequelae. Currently, there are little data that exist on the rate of APs, with the most notable being avascular necrosis (AVN), for pediatric traumatic hip dislocations. The purpose of this systematic review is to evaluate the outcome relative frequency of dislocation direction, reduction type, and rate of APs for traumatic hip dislocations in the pediatric population. Methods: A systematic review on the topic of traumatic hip dislocations in the pediatric population was performed using PubMed, ScienceDirect, Web of Science, CINAHL, and MEDLINE databases from database inception to March 30, 2023. Inclusion criteria was full-text English articles, addressed traumatic hip dislocations, and pediatric patients (<18 y old). Results: A total of 24 articles (n=575 patients) met final inclusion criteria from a total of 219 articles retrieved from the initial search. For the average age of the included patients with reported age (n=433 patients), the frequency weighted mean was 9.50 years±1.75 years with a frequency weighted mean follow-up time of 74.05 months ±45.97 months (n=399 patients). The most common dislocation direction was posterior (86.4%), the most common treatment type was closed reduction (84.5%), AVN was the most common type of LTAEs (15.5% of APs), and labral/capsular injuries and acetabular fractures were the most common type of AIs (14.0% and 9.4% of APs, respectively). There were a combined total of 414 APs (72%) out of 575 total patients. Conclusion: Pediatric traumatic hip dislocations are associated with a high rate of AIs and LTAEs (72%, 414 APs out of 575 patients). AVN, labral/capsular injuries, and acetabular fractures are the most common APs after pediatric traumatic hip dislocations. Pediatric hip dislocations are usually posterior and commonly managed through closed reduction. Level of Evidence: III, Systematic Review.

Acetabular “Fleck” Sign: Outcomes of Surgical Repair

“…6 A Recent systematic review estimates the incidence of traumatic hip dislocation in the pediatric population to be 0.8 per 1 million children. 7 Advanced imaging using computed tomography (CT), or magnetic resonance imaging (MRI) is indicated to assess joint congruity and evaluate for associated pathology after reduction. 8 Surgical treatment may be required in cases involving an ipsilateral femoral head fracture, an incarcerated fragment, or an incomplete reduction.…”

“…Failure to achieve concentric reduction due to soft tissue or bony entrapment occurs in 17% to 25% of cases 6 . A Recent systematic review estimates the incidence of traumatic hip dislocation in the pediatric population to be 0.8 per 1 million children 7 . Advanced imaging using computed tomography (CT), or magnetic resonance imaging (MRI) is indicated to assess joint congruity and evaluate for associated pathology after reduction 8 .…”