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De Salvo S, Lu Y, Shi L, Wang W, Sammartino F, Dimeglio A, Pavone V, Chen S, Li L, Canavese F. Radiological, clinical and functional outcome of children with traumatic hip dislocation: a multicenter review of 66 cases. Arch Orthop Trauma Surg 2025; 145:194. [PMID: 40095028 DOI: 10.1007/s00402-025-05802-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 03/02/2025] [Indexed: 03/19/2025]
Abstract
INTRODUCTION Current understanding of the outcomes of post-traumatic hip dislocation (PHD) in pediatric patients is limited. The purpose of this study is to evaluate the radiologic, clinical, and functional outcomes of patients with PHD, whether isolated or associated with acetabular (ACF) or proximal femoral fractures (PFF), and to identify potential risk factors for adverse outcomes. METHODS This is a retrospective study of pediatric patients with PHD who were consecutively enrolled at three different institutions between 01/2016 and 06/2023. Patients were divided into three groups: PHD (PHD group), PHD with ACF (ACF group), and PHD with PFF (PFF group). Standard radiographs were used to classify each PHD and to identify the presence of other associated bone lesions. Clinical and functional outcomes were assessed using the Harris Hip Score (HHS). Avascular necrosis (AVN) was determined according to the Ratliff criteria. The association between outcome and associated injuries, age at trauma (≤ 10 versus > 11 years), traumatic mechanism (low versus high energy), reduction type (open versus closed), and direction of dislocation (posterior versus anterior) was evaluated. RESULTS Sixty-six cases of unilateral PHD (63 posterior and 3 anterior) were analyzed, consisting of 43 males and 23 females with a mean age of 10.7 years (1-18). Of these, 24 patients were ≤ 10 years old (36.4%), 16 of whom (66.7%) had low-energy trauma. Meanwhile, 42 patients were > 11 years old (63.6%), of which 26 had high-energy trauma (61.9%; p < 0.05). It was observed that patients in the PHD group were significantly younger than those in the ACF and PFF groups (p < 0.05). ACF group had 2/25 patients with misdiagnosed ACF > 3 weeks after injury (8%) and 3/25 with concomitant ACF and PFF (12%), and PFF group had 4/12 patients with AVN (33.3%). Most patients had a favorable mean HHS score, being 97.3 for the PHD group, 93.8 for the ACF group, and 93.6 for the PFF group. CONCLUSION The outcome of PHD is worse in patients with AVN secondary to PFF, simultaneous ACF and PFF, misdiagnosed ACF, high-energy trauma, and older age at the time of injury. Advanced imaging, such as CT scan or MRI is necessary to rule out ACF in isolated dislocations. Timely diagnosis and treatment of these lesions usually result in a favorable outcome. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sara De Salvo
- Department of Pediatric Orthopedic Surgery, Faculty of Medicine, Lille University Hospital, Av. Eugene Avinée, Lille, 59000, France
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania, Italy
| | - Yunan Lu
- Department of Pediatric Orthopedics, Fuzhou Second Hospital, 47th Shangteng Road of Cangshan District, Fuzhou, Fujian Province, 350007, PR China
| | - Liwei Shi
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang City, Liaoning Province, 110004, PR China
| | - Wentao Wang
- Department of Pediatric Orthopedics, Fuzhou Second Hospital, 47th Shangteng Road of Cangshan District, Fuzhou, Fujian Province, 350007, PR China
| | - Fabio Sammartino
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania, Italy
| | - Alain Dimeglio
- Faculty of Medicine, University of Montpellier, 2 Rue de l'École de Médecine, Montpellier, 34090, France
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania, Italy
| | - Shunyou Chen
- Department of Pediatric Orthopedics, Fuzhou Second Hospital, 47th Shangteng Road of Cangshan District, Fuzhou, Fujian Province, 350007, PR China
| | - Lianyong Li
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang City, Liaoning Province, 110004, PR China
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Faculty of Medicine, Lille University Hospital, Av. Eugene Avinée, Lille, 59000, France.
- IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, Genova, 16147, Italy.
- University of Genova, DISC, Viale Benedetto XV, 6, Genova, 16132, Italy.
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Braun ME, Loose O, Schmittenbecher P, Schneidmüller D, Strüwind C, Schwerk P, Reineke S, Traub F, Ihle C, Lieber J, Rüther H, Baumann F, Marzi I, Tüshaus L, Adrian M, Bergmann F, Graf A, Kaiser M, Fernandez FF. Epidemiology and injury morphology of traumatic hip dislocations in children and adolescents in Germany: a multi-centre study. Eur J Trauma Emerg Surg 2023; 49:1897-1907. [PMID: 37261461 DOI: 10.1007/s00068-023-02280-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/12/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Traumatic hip dislocations are very rare in childhood and adolescence. The aim of this multi-centre study is to analyse the current epidemiology and injury morphology of a large number of traumatic hip dislocations in children. This can provide a better understanding of childhood hip dislocations and contribute to the development of a therapeutic approach in order to prevent long-term impacts. METHODOLOGY This retrospective, anonymised multi-centre study included patients, aged up to 17 years, with acute traumatic hip dislocations and open growth plates. The patients came from 16 German hospitals. Exclusion criteria included insufficient data, a positive history of hip dysplasia, or an association with syndromal, neurological or connective tissue diseases predisposing to hip dislocation. An analysis was carried out on the patients' anthropometric data and scans (X-ray, MRI, CT), which were collected between 1979 and 2021. Gender, age at the time of dislocation, associated fractures, mechanism of injury, initial treatment including time between dislocation and reduction, method of reduction, treatment algorithm following reduction and all documented complications and concomitant injuries were evaluated. RESULTS Seventy-six patients met the inclusion criteria. There were two age peaks at 4-8 years and 11-15 years. There was an increased incidence of girls in the under-eight age group, who had mild trauma, and in the group of over-eights there were more boys, who had moderate and severe trauma. Dorsal dislocation occurred in 89.9% of cases. Mono-injuries dominated across all age groups. Concomitant injuries rarely occurred before the age of eight; however, they increased with increasing ossification of the acetabulum and appeared as avulsion injuries in 32% of 11-15-year-olds. Of the 76 patients, 4 underwent a spontaneous, 67 a closed and 5 a primary open reduction. A reduction was performed within 6 h on 84% of the children; however, in around 10% of cases a reduction was not performed until after 24 h. Concomitant injuries needing intervention were identified in 34 children following reduction. Complications included nerve irritation in the form of sensitivity disorders (n = 6) as well as avascular necrosis (AVN) of the femoral head in 15.8% of the patients (n = 12). CONCLUSIONS Traumatic hip dislocations are rare in childhood and adolescence and have high complication rates. The most severe complication, femoral head necrosis, occurred in 16% of cases. Minor injuries, especially in younger children, are enough to cause a dislocation. Posterior dislocation was more frequent and primarily occurred as a mono-injury; however, concomitant injuries must be considered with increasing age. Children continue to experience delayed reductions. The length of time until reduction, age and the severity of the concomitant injury play a role in the development of femoral head necrosis; however, this topic requires additional investigation.
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Momii K, Hamai S, Motomura G, Kubota K, Kiyohara M, Yamamoto T, Nakashima Y. Revascularization of the necrotic femoral head after traumatic open anterior hip dislocation in a child: a case report. J Med Case Rep 2019; 13:254. [PMID: 31416479 PMCID: PMC6696691 DOI: 10.1186/s13256-019-2192-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/05/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Avascular necrosis of the femoral capital epiphysis is the most serious complication after traumatic dislocation of the hip in children. This case report discusses the localization and revascularization of the necrotic femoral head following rarely experienced traumatic open anterior hip dislocation in children. CASE PRESENTATION Our patient was an 11-year-old Japanese boy who had open anterior hip dislocation sustained in a traffic accident. Reduction of the hip joint was performed in an emergency operation, and he was evaluated using serial gadolinium-enhanced magnetic resonance imaging. T1-weighted magnetic resonance images showed two bands with low signal intensity in the femoral capital epiphysis on coronal and oblique axial planes, indicating the existence of avascular osteonecrosis of the femoral head. We observed gadolinium enhancement in the central region of the epiphysis, where the area between the two bands with low signal intensity was located. Serial assessment with enhanced magnetic resonance images during a non-weight-bearing period of 1.5 years after injury showed revascularization starting from the central region and converging toward the peripheral region. Although the patient had leg-length discrepancy due to the early epiphyseal closure, non-weight-bearing treatment for the avascular osteonecrosis of the femoral head achieved a favorable outcome without any hip joint dysfunction, pain, or sign of secondary osteoarthritic change within 4.5 years after injury. CONCLUSION We confirmed the revascularization process of the necrotic lesion in the femoral capital epiphysis in an 11-year-old boy using serial gadolinium-enhanced magnetic resonance imaging. Conservative non-weight-bearing treatment achieved a favorable outcome.
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Affiliation(s)
- Kenta Momii
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,Emergency and Critical Care center, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Goro Motomura
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kensuke Kubota
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,Emergency and Critical Care center, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masato Kiyohara
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Massoud EIE. Neglected traumatic hip dislocation: Influence of the increased intracapsular pressure. World J Orthop 2018; 9:35-40. [PMID: 29564212 PMCID: PMC5859198 DOI: 10.5312/wjo.v9.i3.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 01/12/2018] [Accepted: 02/05/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate that the increased intracapsular pressure, during the delay period, can interrupt the blood flow to the femoral head.
METHODS An observational retrospective study included a group of 17 patients with traumatic hip dislocation, their ages at time of injury averaged 26 (range from 3 to 70) years. Outcomes were assessed clinically and radiographically at a period averaged 11.5 (range from 4 to 20) years.
RESULTS Minor trauma caused dislocation in seven and severe trauma in ten patients. All dislocations were posterior, six isolated dislocation and 11 were associated with other injuries. The negligence period averaged 2.5 (ranged from 1 to 4) d. At the latest visit, the radiography revealed normal hip in 11 and avascular necrosis (AVN) in six patients. Clinically, eight patients were rated as excellent, three good, three fair and three poor.
CONCLUSION We believe the factors that contribute to increased intracapsular pressure also increase the influence of delayed reduction toward the development of AVN.
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Affiliation(s)
- Elsayed Ibraheem Elsayed Massoud
- Department of Orthopaedic, Sohag Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Sohag 0026280, Egypt
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Traumatic, Posterior Pediatric Hip Dislocations With Associated Posterior Labrum Osteochondral Avulsion: Recognizing the Acetabular "Fleck" Sign. J Pediatr Orthop 2016; 36:602-7. [PMID: 25929774 DOI: 10.1097/bpo.0000000000000507] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Traumatic dislocation of the hip is uncommon in the pediatric population. Concentric reduction is usually achieved by closed means. Open reduction may be needed if there is femoral head fracture, incarcerated fragment, or incomplete reduction due to soft tissue entrapment. We present a series of 10 patients who sustained a posterior hip dislocation or subluxation with associated osteochondral avulsion of the posterior labrum. During surgery they were noted to have a labral injury pattern not previously recognized. Such treatment was dictated by postreduction advanced imaging, which revealed a consistent acetabular "fleck" sign indicative of this labral injury, which has not been previously described in literature. METHODS We performed a retrospective case review of patients with traumatic posterior hip dislocation/subluxation, treated operatively for a suspected associated labral tear and fractures. RESULTS Ten patients (2 girls and 8 boys) were identified. Average age was 12.7 years. Eight patients had postreduction computed tomography scans, which revealed a posterior acetabular wall "fleck" sign, suggestive of osteochondral injury. The small bony fragment was consistently displaced at least 2 to 3 mm in all patients with majority of the posterior wall remaining intact. Closed reduction was felt to be congruent in 7 of the 10 patients. All patients were treated operatively for exploration and stabilization of the suspected posterior labrum pathology and associated injuries using a surgical hip dislocation. A consistent pattern of labral pathology was seen in all patients, with disruption of the posterior labrum from the superior 12 o'clock attachment to detachment at the inferior 6 o'clock location. Reattachment of the osteochondral labral avulsion was performed with suture anchors along the posterior rim, and the associated femoral head fractures were also addressed with internal fixation. Two patients had inadequate follow-up and were excluded, the average follow-up for the remaining 8 patients was 9.8 months (range, 6 to 26 mo). There were no findings of avascular necrosis in any of the 8 patients. CONCLUSIONS Posterior hip dislocation in children may produce an acetabular "fleck" sign on advanced imaging, which in a stable, concentrically reduced hip has been treated without surgery in the past. Acetabular fleck sign may represent a near-complete avulsion of the posterior labrum as seen in our series. We recommend a high suspicion for this type of labral pathology and surgical repair when acetabular "fleck" sign is identified with hip subluxation or dislocation. Traumatic, posterior hip dislocations in young patients may be associated with significant labral pathology. Acetabular "fleck" sign on advanced imaging may predict such pathology. LEVEL OF EVIDENCE IV, retrospective study.
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Traumatic dislocation of the hip in a child caused by trivial force for age. Case Rep Orthop 2014; 2014:467246. [PMID: 25525538 PMCID: PMC4261791 DOI: 10.1155/2014/467246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/09/2014] [Indexed: 11/18/2022] Open
Abstract
Traumatic hip dislocation in children has a relatively rare occurrence. There are some residual complications, such as avascular necrosis of the femoral head, growth disturbance caused by premature fusion, neurological injury, recurrent dislocation, and posttraumatic arthritis. There is no consensus in the literature about the period of non-weight bearing after reduction. A rare case of a 13-year-old boy of hip dislocation caused by trivial force for age is reported followed by review of the pediatric literatures with treatment recommendation.
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Bressan S, Steiner IP, Shavit I. Emergency department diagnosis and treatment of traumatic hip dislocations in children under the age of 7 years: a 10-year review. Emerg Med J 2013; 31:425-31. [PMID: 23471165 DOI: 10.1136/emermed-2012-201957] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIMS Traumatic hip dislocations (THD) are uncommon in children. They constitute true emergencies because unrecognised THD leads to avascular necrosis (AVN) of the femoral head. This review presents the evidence for best practice for the diagnosis and treatment of THD in the emergency department (ED) of children under the age of 7 years. METHODS Searches for the period 2002-2012 were performed in PubMED, Cochrane database, EMBASE, Google Scholar and hand search. RESULTS Twenty-five case reports and case series articles were identified, 53 described children with acute and 23 with neglected THD. Overall, 42 (55%) were male and 73 (96%) sustained a posterior dislocation. Forty-eight (63%) had THD following a low-energy trauma. Eight (11%) reported associated injuries. Twenty-one (39.6%) acute dislocations were reduced in the ED without complications. AVN was identified in 3 (5.7%) children, who underwent reduction ≥10 h after dislocation. Redislocation occurred in 3 (5.7%) children and coxa magna developed in 5 (9.4%). Long-term functional outcome of 42 patients resulted in full recovery, and it was fair to good in 3 (including 2 children with AVN). All neglected cases (≥4 weeks from trauma) needed open reduction in the operating room (OR). AVN was identified in 11 children (47.8%). Hip function was completely recovered in 16 (70%) patients. CONCLUSIONS THD in this age group mainly occurs with low-energy trauma and leads to posterior dislocations. Urgent closed reduction of acute cases are done in the OR, or the ED. ED reduction appears to be safe. Neglected THDs need open reduction.
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Affiliation(s)
- Silvia Bressan
- Department of Women's and Children's Health, Division of Pediatric Emergency Medicine, University of Padova, Padova, Italy
| | - Ivan Peter Steiner
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Itai Shavit
- Pediatric Emergency Department, Rappaport Faculty of Medicine, Rambam Health Care Campus, Technion University, Haifa, Israel
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Abstract
The aim of this study was to evaluate the outcomes of reduction in the treatment of traumatic posterior hip dislocation in children. Data of 22 pediatric patients (22 hips) with traumatic hip dislocation from January 1995 to December 2007 were analyzed. The clinical evaluation focused on symptoms, physical findings, and range of motion. Radiographs identified the type of hip dislocation. The hip dislocation classification was based on Thompson and Epstein. The reduction procedure was performed according to three variants: variant 1, closed reduction; variant 2, release of the adductor longus, lengthening of the psoas tendon, and insertion of a Kirschner wire through the femoral head into the acetabulum; and variant 3, removal of the soft-tissue interposition of the hip. After reduction, radiography was used to determine whether the hip is concentric and to check whether any other injuries might have been caused after manipulation. There were six females (27.3%) and 16 males (72.7%) in this study. All had type I posterior dislocation of the hip. The ages of the patients at diagnosis ranged from 3 years, 2 months to 9 years, 10 months. The reduction procedure was performed according to variant 1 in 16, variant 2 in five, and variant 3 in one. We attained excellent results in eight hips (36.4%), good results in seven hips (31.8%), fair results in four hips (18.2%), and poor results in three hips (13.6%). There was avascular necrosis in three hips (13.6%), coxa magna in two hips (9.1%), deficient limb of 2 cm in two hips (9.1%), and a limp in two hips (9.1%). The hip scores were 82.4 points on average (range 62-100). Children with traumatic hip dislocation should undergo reduction as soon as possible. If the interval from injury to reduction exceeds 3 weeks, we suggest that the surgeon release the adductor longus, lengthen the psoas tendon, and insert a Kirschner wire. This simple and safe surgical procedure results in marked improvement in hip function and prevents complications later.
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Abstract
Traumatic hip dislocation in the pediatric patient requires much less energy than in an adult, yet it remains a rare diagnosis. We report the case of a 3-year-old girl who dislocated her right hip when bindings failed to release as she skied downhill. The hip was promptly reduced in the nearest trauma center, and at 18 months after injury, there is no evidence of avascular necrosis. The potential risk of avascular necrosis is significant, and the risk rises greatly when reduction is delayed beyond 6 hours. Reduction can be safely performed in the emergency department, although up to 25% of cases will require open reduction in the operating room. A high index of suspicion is warranted to not miss the "golden window" and achieve satisfactory reduction in a timely fashion.
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Figueras Coll G, Torrededia Del Rio L, Garcia Nuño L, Burniol JR, Huguet Carol R. Traumatic hip dislocation in childhood. Hip Int 2011; 20:524-8. [PMID: 21157759 DOI: 10.1177/112070001002000417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2010] [Indexed: 02/04/2023]
Abstract
We report the outcome of closed reduction of traumatic hip dislocation in 28 children younger than 16 years of age (average age, 8 years 10 months). At an average follow-up of 8 years and 10 months (range, 2 years - 42 years), 18 patients were asymptomatic and enjoying a normal life, and some of them returned to practice sport activities. The remainder had complications related to associated injuries. There were no cases of avascular necrosis of the femoral head during follow-up. The majority of dislocations were attributable to low energy injuries in children younger than 10 years of age. Traumatic hip dislocation in children is uncommon. Management after reduction is not clearly defined in the literature. It is important to perform reduction as soon as possible to avoid later avascular necrosis.
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Affiliation(s)
- Guillem Figueras Coll
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
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Brandão GF, Américo LRD, Soares CBG, Faria RGC, Teixeira LEM. TRAUMATIC POSTERIOR DISLOCATION OF THE HIP IN CHILDREN:REPORT ON FIVE CASES. Rev Bras Ortop 2010; 45:196-9. [PMID: 27022542 PMCID: PMC4799080 DOI: 10.1016/s2255-4971(15)30293-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Objective: To evaluate a series of cases of traumatic posterior dislocations in children, with the treatment and results, and to review issues relating to the epidemiology, clinical and radiographic diagnosis, treatment, complications and prognosis of such cases. Methods: Five patients with traumatic hip dislocation, with a mean age of 4.6 ± 0.9 years and a follow-up period of 19.8 ± 7.0 months, were evaluated retrospectively. The time elapsed between dislocation and reduction, the type of treatment, the associated injuries and the subsequent complications were evaluated. Results: The initial treatment was closed reduction, which was performed on average 5.2 ± 3.6 hours after the initial trauma. All the patients underwent the reduction under anesthesia. The complementary treatment included plaster cast immobilization and traction. No need for additional surgery was observed and there were no long-term side effects. Conclusion: Traumatic dislocation of the hip should be treated quickly by means of closed reduction, with appropriate control over the reduction and rigorous observation in order to diagnose and treat late complications.
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Affiliation(s)
- Gilberto Francisco Brandão
- MSc student of Nuclear Science Techniques at the Federal University of Minas Gerais (UFMG). Pediatric Orthopedist at Hospital da Baleia and Hospital das Clínicas, UFMG
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Tötterman A, Madsen JE, Naess CE, Røise O. Initially neglected tissue interposition after reduction of posterior hip dislocation in a child—a case report. ACTA ACUST UNITED AC 2009; 75:221-4. [PMID: 15180239 DOI: 10.1080/00016470412331294495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Anna Tötterman
- Orthopedic Centre, Ullevål University Hospital, Oslo, Norway.
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Nirmal Kumar J, Hazra S, Yun HH. Redislocation after treatment of traumatic dislocation of hip in children: a report of two cases and literature review. Arch Orthop Trauma Surg 2009; 129:823-6. [PMID: 18719927 DOI: 10.1007/s00402-008-0735-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Indexed: 02/09/2023]
Abstract
From August 1998 to June 2005, we treated five children (age range 2-9 years) with traumatic dislocation of hip. The mean follow-up period was 4.1 years (range 1-8 years). There was acceptable reduction in all cases by single attempt at closed reduction. Two patients aged 2 and 3 years, respectively, had redislocation. Other complications like nerve injuries, avascular necrosis, growth disturbance, ectopic ossification and post-traumatic arthritis were not seen till the last follow-up (mean 4.1; range 1-8 years). Closed reduction is an effective treatment method for traumatic dislocation of hip in children, but adequate immobilization and protection from weight bearing is needed in children aged less than 10 years to prevent redislocation.
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Affiliation(s)
- Jajodia Nirmal Kumar
- Department of Orthopaedic Surgery, Guro Hospital, College of Medicine, Korea University, Guro-gu, Seoul, South Korea
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Abstract
Hip luxations have been reported in many ruminants, and several treatments have been described for them. However, successful closed reduction of hip joint luxation has not been reported in goats to date. This case report describes the closed reduction of coxofemoral luxation in a three-month-old male Saanen dairy goat. The goat showed non-weightbearing lameness and abnormal mobility of the proximal right hindlimb. Luxation of the right coxofemoral joint in craniodorsal direction was diagnosed by radiography. The femoral head was repositioned under sedation, and physiotherapy including non-weightbearing hindlimb movement and supported walking exercise was performed. Fifteen days after closed reduction the animal was discharged from the clinic. At that time the animal was sound at a slow walk but lameness was still present at faster gaits. Follow-up examinations revealed normal development of the animal, which subsequently showed no lameness and served successfully as a breeding goat.
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Affiliation(s)
- J L Khol
- Department for Farm Animals and Herd Management, Clinic for Ruminants, University of Veterinary Medicine, 1210 Vienna, Veterinärplatz 1, Austria.
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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.
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Affiliation(s)
- Raphaël Vialle
- Department of Paediatric Orthopaedics, Necker-Enfants Malades Hospital, Paris, France.
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Vemulapalli KK, Dey C, Peckham T, Paterson JMH. Traumatic hip dislocation in a 21-month-old child. Arch Orthop Trauma Surg 2005; 125:490-2. [PMID: 16052338 DOI: 10.1007/s00402-005-0029-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Indexed: 10/25/2022]
Abstract
Traumatic hip dislocation in the paediatric population is a relatively rare occurrence and constitutes an orthopaedic emergency. A trivial force is all that is required and non-accidental injury should not be necessarily suspected. A case report involving a hip dislocation in a 21-month-old child, the youngest in the recent English literature is detailed.
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Vialle R, Pannier S, Odent T, Schmit P, Pauthier F, Glorion C. Imaging of traumatic dislocation of the hip in childhood. Pediatr Radiol 2004; 34:970-9. [PMID: 15448945 DOI: 10.1007/s00247-004-1299-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2004] [Revised: 07/23/2004] [Accepted: 07/26/2004] [Indexed: 11/25/2022]
Abstract
BACKGROUND Traumatic hip dislocation in childhood is a rare consequence of violent trauma. After reduction, outcome is usually favourable although epiphyseal necrosis can occur. Reduction must be carried out as soon as possible and is achieved easily, although if the labrum is involved, surgery may be required to achieve complete reduction. OBJECTIVE To analyze a retrospective series of traumatic hip dislocations in children, describing the therapeutic and imaging strategy. MATERIALS AND METHODS A total of 42 patients were studied. Their mean age was 10 years 3 months. All relevant radiographic, CT, MRI and radionuclide bone scan examinations were reviewed. Special attention was paid to associated lesions. RESULTS In 22 patients the dislocation was caused by low-energy trauma. Road traffic accidents accounted for 17 dislocations. An acetabular fracture was present in six patients and the femoral head was fractured in three. Reduction was easily achieved in 31 patients. In 11 patients the postreduction radiograph and CT showed joint space asymmetry secondary to labral entrapment. Only two patients developed epiphyseal necrosis. CONCLUSIONS It has been difficult to define and evaluate accurate principles for a medical imaging strategy in this group of patients. Analysis of plain radiographs is essential before and after reduction of the joint, and it is important to perform postreduction CT in every patient whose joint space remains widened. A radionuclide bone scan should be performed between the second and third weeks after injury to assess epiphyseal vascularity. With the use of specific sequences, MRI may be an alternative modality to assess epiphyseal vitality.
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Affiliation(s)
- Raphaël Vialle
- Department of Paediatric Orthopaedics, Necker Enfants-Malades Hospital, 149 rue de Sèvres, 75743 Paris Cedex 15, France.
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Abstract
Traumatic posterior dislocation of the hip joint in children is an uncommon injury. It constitutes a true orthopedic emergency. It makes up over 80% of pediatric hip dislocations. In children, it can occur as a result of minimal trauma, which is attributed to a soft pliable acetabulum and ligamentous laxity. In skeletally mature adolescents, a greater force is required to dislocate the hip joint. Delay in reduction is associated with long-term complications such as avascular necrosis and degenerative arthritis. Avascular necrosis is related to the duration of dislocation. A poorer prognosis is associated with delay in reduction beyond 6 hours, advanced skeletal maturity, or multiple traumas. Prompt reduction minimizes complications. We report two cases of traumatic posterior dislocation of hip in children aged 3 and 14 years. Both were reduced within 6 hours of dislocation, and review at 6 months revealed normal examination and no evidence of any post-traumatic changes. Post-reduction treatment remains without a consensus. This review highlights the clinical presentation, management, and time-sensitive complications of the injury.
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Affiliation(s)
- S Kutty
- Department of Orthopedics, University College Hospital Galway, Republic of Ireland.
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Abstract
In the current study, the incidence, presentation, and treatment of traumatic dislocation of the hip in children will be discussed. The complications and the possible pathologic changes behind the development of avascular necrosis are described. Most children have a good outcome after this injury, perhaps because a concomitant fracture is unusual. The results in children are significantly better than results in adults.
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Hughes MJ, D'Agostino J. Posterior hip dislocation in a five-year-old boy: a case report, review of the literature, and current recommendations. J Emerg Med 1996; 14:585-90. [PMID: 8933320 DOI: 10.1016/s0736-4679(96)00131-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Traumatic hip dislocation constitutes a true orthopedic emergency, is a relatively rare occurrence in the pediatric population, and may be accompanied by minimal trauma. Long-term morbidity such as avascular necrosis or osteoarthritis of the femoral head may be significant if the diagnosis is not expeditiously confirmed radiographically and prompt reduction employed. A poorer prognosis is conferred by duration of dislocation for longer than 6 h, advanced skeletal maturity of the patient, severe joint injury, or multiple trauma in the affected patient. A case report involving traumatic hip dislocation in a 5-yr-old boy is described followed by a comparative review of the pediatric and adult literature with current recommendations.
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Affiliation(s)
- M J Hughes
- Joint MSU affiliated Lansing Emergency Medicine Residency, East Lansing, Michigan, USA
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Laorr A, Greenspan A, Anderson MW, Moehring HD, McKinley T. Traumatic hip dislocation: early MRI findings. Skeletal Radiol 1995; 24:239-45. [PMID: 7644933 DOI: 10.1007/bf00198406] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Objective of this study was to present the spectrum of early magnetic resonance imaging (MRI) findings following traumatic dislocation of the femoral head, and to identify any associated injuries that may have therapeutic or prognostic significance and be better delineated by MRI than by conventional radiography. PATIENTS AND METHODS Prospective MRI of both hips was formed on 18 patients (14 male, 4 female; age range 14-54 years; average age 30.5 years) within 5 weeks of a traumatic femoral head dislocation. The interval between the time of injury and the time of injury and the imaging studies ranged from 2 to 35 days (average 13.2 days). Posterior dislocation was present in 14 patients and anterior dislocation in 4 patients. In the majority of cases, we performed axial T1, coronal T1, and coronal T2* (MPGR) sequences. Images were retrospectively evaluated by consensus of three radiologists for possible abnormalities of the bone and cartilage, joint space, and soft tissues. Because all patients were treated with closed reduction, surgical correlation was not obtained. RESULTS All patients had a joint effusion or hemarthrosis. Of the 14 patients with posterior dislocation, isolated femoral head contusions (trabecular microfractures) were identified in 6 patients. Four patients had small femoral head fractures, and one had an osteochondral defect. Acetabular lip fractures were seen in six patients, and one patient had a labral tear. Four patients had intra-articular loose bodies and one had ligamentum teres entrapment. Twelve patients had iliofemoral ligament injury. All patients had muscle injury involving the gluteal region and medical fascial compartment, and 13 patients had anterior fascial compartment muscle injury. Seven patients with posterior dislocation had posterior fascial compartment injury. Of the four patients with anterior dislocation, two had bony contusion, two had cortical infraction, one had a labral tear, and all four had an iliofemoral ligament injury. All four patients in this group had muscle injury of the gluteal region and of the anterior and medial fascial compartments. CONCLUSIONS MRI can effectively identify and quantify the muscle injury and joint effusion that invariably accompany traumatic hip dislocations. It is also useful for demonstrating trabecular bone contusion (trabecular injury) and iliofemoral ligament injury, which occur commonly with acute hip dislocation.
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Affiliation(s)
- A Laorr
- Department of Radiology, University of California, Davis Medical Center, Sacramento 95817, USA
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