Traumatic Hip Dislocation Associated with Proximal Femoral Physeal Fractures in Children: A Systematic Review

Abstract

Traumatic hip dislocation might lead to serious complications and a poor outcome. Fortunately, it is a rare condition in pediatric patients. The purpose of this study is to establish and describe the complications caused by hip dislocations associated with transphyseal femoral neck fractures. Therefore, we conducted a literature review that resulted in 11 articles, including 32 patients, older than 10 years of age, suffering from traumatic hip dislocation associated with a transphyseal femoral neck fracture. We presented a case series of three patients with hip fracture-dislocation treated in our clinic that were also evaluated and included in the study. For the 35 patients included in the study group, the percentage of avascular osteonecrosis after hip fracture-dislocation was 88.57%. Traumatic hip dislocation associated with transphyseal femoral neck fracture is a rare condition and has a poor prognosis because of the high incidence of femoral head avascular necrosis (AVN). Reduction should be attempted within six hours the from injury, but this may not minimize the risk of AVN if transphyseal separation occurs. The approach may influence the development of AVN; lateral approach of the hip with great trochanter osteotomy seems to have the lowest number of cases of AVN.

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

“…Traumatic hip dislocations in the pediatric population is a rare phenomenon, which increases difficulty of proper management 1–3,5 . There has been recent interest in the literature for a systematic review concerning pediatric traumatic hip dislocations, but the number of included articles and patients was small, thus limiting results 13 . A total of 24 articles were included in this systematic review with a total of 575 pediatric patients who had a traumatic hip dislocation.…”

“…[1][2][3]5 There has been recent interest in the literature for a systematic review concerning pediatric traumatic hip dislocations, but the number of included articles and patients was small, thus limiting results. 13 A total of 24 articles were included in this systematic review with a total of 575 pediatric patients who had a traumatic hip dislocation. Posterior hip dislocations were the most common (n = 370 dislocations), representing 86.4% of the total reported dislocations with specified dislocation direction.…”

“…However, the literature on pediatric traumatic hip dislocations has mostly been case series with literature reviews and has been devoid of any recent comprehensive systematic review examining the AEs associated with pediatric traumatic hip dislocations 1,2,12 . As an example, a recent case series with literature review examined the incidence of proximal femoral physeal fractures due to pediatric traumatic hip dislocations 13 . Closed and open reduction techniques have been reported in the literature, but there is little evidence on the outcomes associated with these techniques 3,14 …”

“…1,2,12 As an example, a recent case series with literature review examined the incidence of proximal femoral physeal fractures due to pediatric traumatic hip dislocations. 13 Closed and open reduction techniques have been reported in the literature, but there is little evidence on the outcomes associated with these techniques. 3,14 There exists no systematic review in the literature that examines the utility rates of open versus closed reduction techniques for pediatric traumatic hip dislocations.…”

Traumatic injuries of the immature hip and pelvis

“…Studies that consider the timing of surgical fixation suggest that early reduction [40] is necessary to avoid ischaemic injury [19,41,42]. The risk of AVN, however, may be determined by the patients age [43] and fracture pattern [44], irrespective of how and when the proximal femur is stabilized [19,42].…”