Die Bedeutung des MRT nach geschlossener Reposition der traumatischen Hüftgelenkluxation im Kindes- und Jugendalter

Strüwind, Christoph; Rüden, Christian von; Thannheimer, Andreas; Bühren, V.; Schneidmueller, Dorien

doi:10.1055/a-0600-2979

Cited by 7 publications

(7 citation statements)

References 30 publications

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“…This imaging modality was able to identify all intraoperatively confirmed lesions preoperatively, while CT imaging underestimated posterior wall injuries given the later ossification of this structure during normal development. 16 , 17 In 2018, Strüwind et al 14 demonstrated the utility of MRI in identifying labral interposition following closed reduction of these dislocations, especially given that two of their patients who had a free body identified on CT had missed labral interpositions when subsequently managed operatively. Similar findings were reported by Thanacharoenpanich et al 28 in 2020, who found that not only did MRI capture all bony injuries also identified by CT, but MRI also identified one posterior acetabular injury and three labral entrapments that CT could not.…”

Section: Discussionmentioning

confidence: 99%

“…1,3,6,8,[10][11][12] While radiographs both pre and postreduction are established as standard of care in the management of this sort of injury, the role of computed tomography (CT) and especially magnetic resonance imaging (MRI) in the acute phase of managing traumatic hip dislocations in the pediatric population remains more heterogeneous. 6,[13][14][15] As a function of the developing skeleton's pattern of ossification, injuries in the skeletally immature may not be readily apparent on plain radiographs or even CT. Fabricant et al 16 demonstrated that posterior acetabular wall ossifi cation typically occurs around 12-13 years of age, just prior to the closure of the triradiate cartilage. Therefore, accurate imaging is critical to fully understand these inju ries, especially given that the majority are managed through closed reduction, in which direct visualization of intraarticular structures is impossible.…”

Section: Introductionmentioning

confidence: 99%

“… 1 , 3 , 6 , 8 , 10 – 12 While radiographs both pre- and postreduction are established as standard of care in the management of this sort of injury, the role of computed tomography (CT) and especially magnetic resonance imaging (MRI) in the acute phase of managing traumatic hip dislocations in the pediatric population remains more heterogeneous. 6 , 13 – 15 …”

Section: Introductionmentioning

confidence: 99%

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Traumatic hip dislocations in a pediatric cohort: The importance of advanced imaging

Yang

Lee

Orellana

et al. 2023

Journal of Children's Orthopaedics

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Purpose: Given that pediatric traumatic hip dislocations are relatively rare, the purpose of the current study is twofold: first, to contribute a significant cohort to the existing corpus, and second, to provide evidence toward the role that computed tomography and magnetic resonance imaging could play in identification and management of this type of injury. Methods: A retrospective review was conducted of all patients with traumatic hip dislocation who presented from 2012 to 2022 at a tertiary-level pediatric trauma center. Data regarding demographics, mechanism of injury, imaging, and treatment were tabulated. Outcomes of interest included immobilization length, concomitant injuries, imaging performed and findings, and rates of avascular necrosis, pain, and stiffness. Concomitant injuries were identified using imaging, clinical, and operative notes. Differences between categorical variables were compared using chi-square analysis or Fischer-exact testing, while continuous variables were compared using Student t tests or Wilcoxon rank sum tests when appropriate. Results: Thirty-four patients were identified. Postreduction, 28 patients had a cumulative 17 magnetic resonance imaging, 19 computed tomographies, and 1 intraoperative arthrogram. Of these, 16 patients had 19 injuries identified on advanced imaging that were missed on initial radiographs. Eleven of these patients went on to operative treatment. In eight of these, postreduction advanced imaging helped guide the decision for surgery. In four patients, magnetic resonance imaging was necessary to fully characterize injury to the posterior acetabular rim after initial identification on computed tomography. Magnetic resonance imaging was also used to rule out one computed tomography-diagnosed acetabular fracture. Conclusion: Magnetic resonance imaging is valuable to fully define associated rim and intra-articular injuries following initial treatment of pediatric traumatic hip dislocations. Level of evidence: Level IV diagnostic study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Traumatic hip dislocations in a pediatric cohort: The importance of advanced imaging

Yang

Lee

Orellana

et al. 2023

Journal of Children's Orthopaedics

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“…Traumatic hip dislocations are exceedingly rare in childhood and adolescence (Macnicol, 2000;Mehlman et al, 2000;Kutty et al, 2001;Ayadi et al, 2008;Brandão et al, 2010;Bressan et al, 2014;Strüwind et al, 2018).…”

mentioning

confidence: 99%

“…Currently, conventional X-rays are established as the standard both before and after reduction. However, computed tomography (CT) and particularly magnetic resonance imaging (MRI) are attributed with a heterogeneous signi cance in the acute phase of traumatic hip dislocation (Vialle et al, 2005;Blanchard et al, 2016;Strüwind et al, 2018). Fabricant et al demonstrate that ossi cation of the posterior acetabular wall usually occurs between twelve and thirteen years of age (Fabricant et al, 2013), and that conventional X-rays and CT scans may not effectively depict the non-ossi ed, developing, cartilaginous portions of the immature acetabulum (Yang et al, 2023).…”

mentioning

confidence: 99%

Traumatic Hip Dislocations in Children and Adolescents: Diagnostic Challenges and the Significance of MRI Imaging - A Multi-Center Study

Braun,

Fernandez,

Riha

et al. 2024

Preprint

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Background Traumatic hip dislocations in children and adolescents are rare but associated with significant consequences such as secondary coxarthrosis and avascular necrosis of the femoral head. Delayed reductions are cited in the literature as a primary cause, mainly due to radiologically overlooked dislocations. The heterogeneous symptomatology and primary care in regular emergency departments complicate the diagnosis. This multi-center study aims to evaluate the various diagnostic steps and propose an improved algorithm for diagnosing traumatic hip dislocations in childhood. Methods This retrospective multi-center study included 76 patients aged up to 17 years with acute traumatic hip dislocations and open growth plates from 16 German hospitals. Exclusion criteria included insufficient data, positive history of hip dysplasia, and association with syndromal, neurological, or connective tissue disorders predisposing to hip dislocation. Analysis included anthropometric data and imaging (ultrasound, X-ray, MRI, CT) from 1979 to 2022. Examined parameters included gender, age, associated fractures, mechanisms of injury, initial care, time to reduction, associated injuries, and diagnostic modalities. Statistical analysis was performed using SPSS while strictly adhering to ethical guidelines. Results 76 patients met the inclusion criteria. Primary imaging showed a clear dominance in X-ray diagnostics in one plane 46% (n = 35) and two planes 39% (n = 30). In 87% of the cases (n = 66), dislocations were diagnosed during initial presentation. Dislocations were missed in 12% (n = 9), with seven children under the age of eight years old. Fifty percent of dislocations of those under four years old were not detected. Delayed reduction occurred in 12 children (15.8%), with 8 patients undergoing reduction more than 24 hours after trauma. The reason in 12% of the cases (n = 9) was an undetected dislocation in imaging. Dislocations were particularly commonly overlooked in conventional X-rays, whereas none were missed in MRI. Fifty-four patients (71%) had associated injuries, of which 57.9% (n = 44) were diagnosed only with MRI. Conclusion Successful primary diagnosis of traumatic hip dislocations, which are delayed in 15% of cases and carry an increased risk of femoral head necrosis, requires an algorithm, especially for young children where dislocations are often not automatically suspected. MRI plays a crucial role in the secondary diagnostic phase due to the high incidence of associated injuries. MRI provides a more precise depiction, especially of cartilaginous acetabular avulsions and soft tissue interpositions. These findings underscore the indispensable role of MRI diagnostics in traumatic hip dislocations and a unified diagnostic algorithm. Level of Evidence: IV

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Epidemiology and injury morphology of traumatic hip dislocations in children and adolescents in Germany: a multi-centre study

Braun

Loose

Schmittenbecher

et al. 2023

Eur J Trauma Emerg Surg

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Die Bedeutung des MRT nach geschlossener Reposition der traumatischen Hüftgelenkluxation im Kindes- und Jugendalter

Abstract: MRI is gaining increasing importance following traumatic hip dislocation in children and adolescents. A missing chondral or osteochondral fragment in the CT scan does not exclude a labral lesion or interposition. Therefore, MRI following closed reduction is mandatory in any case.

Cited by 7 publications

References 30 publications

Traumatic hip dislocations in a pediatric cohort: The importance of advanced imaging

Traumatic hip dislocations in a pediatric cohort: The importance of advanced imaging

Traumatic Hip Dislocations in Children and Adolescents: Diagnostic Challenges and the Significance of MRI Imaging - A Multi-Center Study

Epidemiology and injury morphology of traumatic hip dislocations in children and adolescents in Germany: a multi-centre study

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