Management of Neglected Traumatic Hip Dislocation in Children

Abstract

Background: Neglected traumatic hip dislocation in children is uncommon and there is no consensus on appropriate management. Previous studies report varied operative management with high rates of avascular necrosis and postoperative subluxation/dislocation. We report a series of 7 consecutive cases who underwent operative reduction after neglected hip dislocation and describe our technique for treatment. Methods: All 7 children sustained posterior dislocations and had no treatment before presentation at our institution. An associated marginal acetabular fracture was present in 2 cases. One additional patient was excluded from the study due to complete loss of articular cartilage that precluded open reduction. The mean time before surgical intervention was 13.1 months (4 to 36 mo) with a mean age of 7 years (5.3 to 10.8 y). All children underwent preoperative skeletal traction for 10 to 14 days. A postero-lateral approach was used in all cases. The acetabulum was cleared of scar tissue and a femoral shortening performed as required (5 cases). Minor erosion of the articular cartilage of the posterior aspect of the femoral head was noted in 3/6 cases. After reduction, a posterior capsulorrhaphy was performed and the patient immobilized in a hip spica for 6 to 12 weeks. Results: The mean follow-up was 44 months (33 to 56 mo). The majority of children (86%) could walk and run without a limp, could squat, and had no pain. One child had mild pain and a limp. Mean Harris Hip Score was 98.9. No hip subluxed or dislocated postoperatively. The radiographs at latest follow-up showed no evidence of growth disturbance in 29% of cases, coxa magna in 57%, and partial femoral head collapse in 1 case (14%). Of note, those patients managed within 8 months of injury had none or minimal evidence of growth disturbance. Conclusions: At medium-term follow-up, open reduction with a postero-lateral approach, posterior capsulorrhaphy, and femoral shortening (as required) produces a satisfactory outcome with a stable, congruent reduction. Good clinical function can be expected with a low incidence of avascular necrosis. Level of Evidence: Level IV.

Neglected Posterior Hip Dislocation in Adults presenting after One Year Managed Successfully with Single Stage Total Hip Arthroplasty: A Case Series

“…As the energy of trauma is also an important factor in causing AVN with high energy trauma having more chances of AVN [ 11 , 12 , 13 ]. Few authors have reported rates of 0–15% of AVN even in cases of neglected dislocations mostly in children which can be attributed to the low energy of trauma [ 2 , 3 , 4 ].…”

“…Due to rarity, there is a paucity of literature and hence a suitable algorithm of management for these cases in young adults is lacking. Most of the published articles related to neglected dislocations have been in children who have largely been managed by open reduction with variable results [ 1 , 2 , 3 , 4 ]. Adults however differ from children in some aspects which throws additional challenges in their management.…”

Traumatic Hip Dislocations in Major Trauma Patients: Epidemiology, Injury Mechanisms, and Concomitant Injuries

“…In the current study, most THDs were diagnosed early during the initial evaluation (98.9%), before admission to the ICU. Unconscious, pediatric, and hemodynamically unstable patients seem to be especially at risk for delayed or neglected diagnosis [32,35] and require special attention during the thorough evaluation in secondary and tertiary surveys as soon as life-threatening conditions are ruled out.…”

The Importance of Allis Maneuver in the Management of Traumatic Posterior Hip Dislocation in Children: A Report of Two Cases

“…Traumatic hip dislocation is an uncommon condition in children which requires prompt diagnosis and management [1,2]. Due to the laxity of the joint structures at younger age, the dislocation may happen with a low-energy trauma [3,4].…”