Die Traumatische Hüftgelenkluxation eines 6‑jährigen Jungen: Selten, aber anspruchsvoll

Mörsdorf, P.; Lauer, A.; Histing, Tina; Pohlemann, Tim; Burkhardt, Markus

doi:10.1007/s00113-016-0268-z

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…Therefore, EPs should be familiar with several different techniques to increase the odds of success 11. Early consultation with pediatric orthopedic surgery is recommended and patients should be followed and examined for resulting AVN and/or growth disorders 6,12…”

Section: Discussionmentioning

confidence: 99%

Emergency Physician Reduction of Pediatric Hip Dislocation

Capehart

Balcik

Sikora

et al. 2019

Clinical Practice and Cases in Emergency Medicine

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Traumatic hip dislocation in children is relatively rare but presents a true emergency, as a delay in reduction can result in avascular necrosis of the femoral head and long-term morbidity. After sustaining a traumatic posterolateral hip dislocation, a seven-year-old boy presented to an outside facility where no attempt was made at reduction. The patient was transferred to our emergency department (ED) where he was promptly sedated and the dislocation was reduced in a timely manner. Emergency physicians have demonstrated high success rates with dislocation reduction. ED reduction should occur immediately to reduce the likelihood of long-term complications. While timely consultation with a pediatric orthopedist is recommended, that should not delay reduction. The reduction should ideally be performed before the patient leaves the department or is transferred to another facility.

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Section: Discussionmentioning

confidence: 99%

Emergency Physician Reduction of Pediatric Hip Dislocation

Capehart

Balcik

Sikora

et al. 2019

Clinical Practice and Cases in Emergency Medicine

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“…capitis femoris müssen mittels MRT ausgeschlossen und ggf. operativ angegangen werden [19]. Die Nachbehandlungsempfehlungen variieren von Ruhigstellung im Becken-Bein-Gips für 4-6 Wochen über vorübergehende Extensionsbehandlung bzw.…”

Section: Luxationen Der Unteren Extremitätunclassified

“…Die Nachbehandlungsempfehlungen variieren von Ruhigstellung im Becken-Bein-Gips für 4-6 Wochen über vorübergehende Extensionsbehandlung bzw. Bettruhe bis hin zur frühfunktionellen Mobilisation mit oder ohne Belastung [19]. Klinische und radiologische Kontrollen bis zum abgeschlossenen Wachstum sind zu empfehlen, um eine sekundäre Hüftkopfnekrose, periartikuläre Ossifikationen, eine Coxa magna oder allgemeine Wachstumsstörungen auszuschließen.…”

Section: Luxationen Der Unteren Extremitätunclassified

Versorgung von Notfällen in der Kinder- und Jugendtraumatologie

Wintges¹,

Reinshagen²,

Frosch³

et al. 2021

OP-JOURNAL

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ZusammenfassungMit zunehmendem Alter und Bewegungsradius kommt es bei der Entdeckung der Umwelt zu alterstypischen Unfällen und Verletzungen im Kindes- und Jugendalter. Diese führen häufig zur Vorstellung in einer pädiatrischen Notaufnahme. Neben Unfällen im Haushalt kommt es dabei am häufigsten beim Spielen auf Spielplätzen, der Sportausübung sowie im Straßenverkehr zu Verletzungen. Durch ihre anatomischen und physiologischen Unterschiede zum Erwachsenen sind Verletzungen im Kindesalter nicht immer mit denen Erwachsener zu vergleichen und benötigen daher kindgerechte Behandlungskonzepte. So muss zum Beispiel bei der Versorgung von Frakturen immer das noch ausstehende Korrekturpotenzial aufgrund der noch offenen Wachstumsfugen berücksichtigt, jedoch auch immer die Gefahr einer drohenden Wachstumsstörung bedacht werden. Neben Frakturen kommt es bei Kindern häufig zu Weichteilverletzungen vor allem am Kopf oder den Händen. Dabei reichen die Verletzungen von einfachen Rissquetsch- oder Schnittwunden bis hin zu Teilamputationen oder (Tier-)Bisswunden sowie thermischen Verletzungen. Luxationen der großen Gelenke stellen im Kindesalter eine Rarität dar, können aber falsch behandelt zu persistierenden Bewegungseinschränkungen oder chronischer Instabilität führen. Das Polytrauma im Kindesalter sollte aufgrund der Seltenheit und einer dadurch an kleineren Häusern oft fehlenden routinierten Behandlung wenn möglich in spezialisierten kindertraumtologischen Zentren erfolgen. Bei inadäquatem Unfallmechanismus, widersprüchlicher Anamnese oder auffälligen Verletzungen muss im Kindesalter auch immer an eine Kindesmisshandlung gedacht werden.

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“…When causality is cited in literature, overlooked dislocations with conventional radiology are primarily discussed. It is speculated that this is due to pain-related di culties and thus inadequate imaging (Mörsdorf et al, 2016), as well as to associated injuries in polytrauma cases (Sanders et al, 2010). Another explanation for overlooked dislocations is the circumstances of childhood emergency care in the context of traumatic hip dislocation.…”

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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Die Traumatische Hüftgelenkluxation eines 6‑jährigen Jungen: Selten, aber anspruchsvoll

Cited by 5 publications

References 9 publications

Emergency Physician Reduction of Pediatric Hip Dislocation

Emergency Physician Reduction of Pediatric Hip Dislocation

Versorgung von Notfällen in der Kinder- und Jugendtraumatologie

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

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