Traumatic Anterior Dislocation of the Hip Associated with Ipsilateral Femoral Shaft Fracture in a Child: A Case Report

Abstract

Traumatic anterior dislocation of the hip joint in children is rare, and only one case with ipsilateral femoral fracture has been reported in Japan. We report a case of such dislocation and a review of the literature. The patient was a 31-month-old girl who was injured in a car accident while asleep on a tilted front passenger seat. Radiographic examination showed dislocation of the right obturator foramen and transverse fracture of the ipsilateral femoral shaft. The dislocation of the right hip was easily reduced without anaesthesia during radiography. We applied Bryant traction after reduction for 4 weeks, followed by cast application for 3 weeks. Walking with support and full weightbearing were permitted 14 weeks and 16 weeks after the injury, respectively. Radiography at 4.5 years after the injury showed a mildly enlarged right femoral head and femur overgrowth of approximately 8 mm. Magnetic resonance imaging showed no evidence of suspected avascular necrosis of the femoral head. The patient has no subjective or objective symptoms, and is able to engage in all usual activities. The detailed mechanism of the injury is unknown. We assume that the lower leg was dislocated through abduction during flexion, or abducent, external flexion, considering that the child was sleeping at the time of the accident. Since she was hurled to the back seat, it was assumed that strong external force was vertically added to the femur, which caused the abducent force.

An Update on Traumatic Joint Dislocations in Nigeria

“…74.4% was reported in Brazil [19]. A Japanese review of traumatic dislocations of the hip in children found that <5% of hip dislocations were associated with femoral fractures [42].…”

Ipsilateral obturator type of hip dislocation with fracture shaft femur in a child: a case report and literature review

“…Barquet et al [1] in a case report reviewed the literature and found 35 cases of ipsilateral hip dislocation with fractures of the shaft femur. The injury combination reported above is extremely rare, with only two similar cases being reported in the English literature to date in the paediatric age group [6,7]. In adults, injury combinations of obturator type of anterior hip dislocation with fracture neck femur [8] or intertrochanteric [9]/subtrochanteric femur fractures [10] have been reported, but not in combination with shaft femur fracture.…”

“…On impact with a four-wheeler from behind, the boy must have been compressed between the two individuals because of sudden deceleration, leading to hyperabduction of the hip, thereby causing an Reduction of the dislocated hip is the priority in the management of such cases. In a similar case reported by Yamamoto et al [7], the anterior hip dislocation reduced spontaneously while obtaining plain radiographs. Malkawi et al [6] reported a case with a similar injury profile in a 7-yearold male child, but in this case, the femur fracture was subtrochanteric in location and the anteriorly dislocated femur head also caused occlusion of the femoral artery.…”

“…Closed reduction and intramedullary nailing of fracture shaft of the femur using a trochanteric entry portal was performed using the standard technique considering the age of the child; similar cases in the past have been managed either by hip spica [7] or with an external fixator [10] for fixing shaft femur fractures (Table 1).…”

“…Anterior dislocation of the hip is relatively rare; it may be either iliac or obturator type depending on the attitude of limb (flexion or extension, respectively) at the time of impact [4,5]. Obturator type of anterior hip dislocation in a child is very rare; associated ipsilateral fracture of the femoral shaft is even rarer, with only two cases being reported in the scientific English literature to date [6,7].…”