Traumatic Hip Dislocation in Childhood

Abstract

Traumatic dislocation of the hip in childhood is uncommon and can be a consequence of minor trauma. The authors report a series of 35 dislocations in skeletally immature patients. Most were isolated posterior dislocations without acetabular lesions. In 75% of cases, reduction of the dislocation was easy. Nine children required surgery to remove interposed joint capsule and/or osteochondral fragments to achieve anatomic reduction. Outcomes were generally good, except in one patient in whom a displaced fracture of the femoral physis was followed by total head avascular necrosis. One case of partial necrosis had a satisfactory outcome. Epiphyseal necrosis, though uncommon, appeared to be inconsistent to prevent and hard to predict. Bone scan seems to be more effective than MRI for the detection of necrosis.

Treatment and Results in Paediatric Traumatic Hip Dislocation: Case series and review of the literature

“…Especially, if concentric reduction cannot be provided in older children, osteochondral fracture should be kept in mind. [17,18] In their study, Mehlman et al [16] had not encountered any radiological or functional sequel in four patients with up to 6 mm asymmetric joint enlargements after closed reduction. Vialle et al [17] had not determined any correlations between the severity of trauma and soft tissue entrapment or osteochondral fracture in their study.…”

“…[14,19] In the literature, AVN rate has been reported 3-15% in patients whose reduction has been performed in six hours. AVN rate reaches up to 100% in neglected THD patients [9,13,[15][16][17]19,27] However, recent studies have found that AVN rate is less than 5%. [12,17] Additionally, AVN rate has been reported 80-100% in children with fractured dislocation.…”

“…It is three to four times more frequently encountered in boys than girls. [5,[16][17][18] Posterior dislocations are much more frequent than anterior dislocations similar to the adult age group. [5,6,14,19] Our findings were consistent with the literature.…”

Traumatic Posterior Dislocation of The Hip in A 3 Year-old Child

“…Reduction performed in the ED reduces the total elapsed time between injury and reduction, and this is well known as the most important factor for the vitality of femoral head (7). Because of that reduction is usually easy to achieve with gentle manipulation, reduction in the ED is recommended for most hip dislocations in children (6,8). Especially in the conditions which may cause to delay general anesthesia, such as that the operating theater is full, reduction should be performed as soon as possible in the ED.…”

Closed Bone Graft Epiphysiodesis for Avascular Necrosis of the Capital Femoral Epiphysis

“…It occurs in 15% to 58% of unstable slipped capital femoral epiphyses (SCFEs) [10,16,21,30,31,37] and is common after pediatric femoral neck fractures, affecting 10% to 43% of involved hips [5,18,24,26,35,36]. It occurs less commonly in patients with traumatic dislocations of the hip, affecting 3% to 15% of involved hips [2,11,13,14,24,27,41].…”