Outcome of traumatic hip dislocation in children

Abstract

We reviewed 13 patients without an underlying syndrome with traumatic hip dislocation between 3 and 10 years of age (mean 4.8 years) at the time of injury. The final reviews were between 1 and 11 years (mean 6 years). All children had posterior dislocation, except one, who had an anterior dislocation. Time taken from trauma to reduction was less than 6 h in three patients, 6 h to 1 day in two patients, 1 day to 3 weeks in seven patients, and 4 weeks in one. All of them underwent closed reduction, except two, who required open reduction through a posterior approach. All patients had excellent hip function and radiographic result on the basis of Garret classification, except for one with limping at 4 years after trauma. The patients treated with hip spica after reduction (10 patients) did not have recurrent dislocation whereas two out of three patients who were treated without postreduction hip spica developed recurrent dislocation. One out of 13 patients without an underlying syndrome and a 6-year-old patient with Down syndrome with neglected hip dislocation and radiological avascular necrosis at presentation recovered with congruent hip following a complete and maintained reduction. This case series suggested that closed reduction was possible for cases of neglected hip dislocation for up to 3 weeks. Open reduction through the posterior approach was safe in neglected irreducible posterior hip dislocation. Those hips that underwent complete reduction and were maintained reduced with hip spica had an excellent functional outcome even in the presence of avascular necrosis. This is a level IV study.

Open anterior dislocation of the hip in child of 7-years-old: A case report and literature review

“…Avascular osteonecrosis of the femoral head may occur within 2e12 months or even 24e36 months evolution and occurs mainly in older children (older than 6 years). 2 In our patient, who was 7 years old, it occurred after 2 months of evolution, despite early reduction (2 hours after the trauma). We think that the importance of displacement, with a concomitant rupture of the ciconflex arteries, inevitably leads to osteonecrosis of the femoral head.…”

“…The risk of occurrence coxa magna has also been reported by some authors. 2 The type and duration of immobilization are variable according to the authors.…”

“…Traumatic dislocation of the hip is a rare disease in children, only single cases or short series of cases observed over long periods have reported. 1,2 It occurs 25 times more frequently in adults than in children. 2 It is estimated that traumatic dislocations child's hip represent 2e5% of all dislocations.…”

“…1,2 It occurs 25 times more frequently in adults than in children. 2 It is estimated that traumatic dislocations child's hip represent 2e5% of all dislocations. 1 The dislocation of the hip in children under 5e6 years may occur during trivial trauma, this being due to the low articular congruence due to the cartilaginous part of the acetabulum and ligamentous laxity 3 ; whereas after 6 years, they are secondary to violent trauma.…”

“…Dislocations of the hip are mostly closed, the most common complication being avascular osteonecrosis. 2 Beside them, there are open dislocations of the hip, which are even rarer following a violent trauma 4e9 ; the skin effraction occurs from within outwards, tearing of soft tissue and skin by the femoral head with the risk of occurrence of posttraumatic septic arthritis. 7 It is a therapeutic emergency order to prevent the occurrence of these complications.…”