Traumatic dislocation of the hip in a child caused by trivial force for age

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

INTRODUCTION

Pediatric traumatic hip dislocations are a rare condition that can have devastating short and/or long-term outcomes and associated pathologies (APs), including associated injuries (AIs) and long-term adverse events (LTAEs), with negative long-term sequelae. Currently, there are little data that exist on the rate of APs, with the most notable being avascular necrosis (AVN), for pediatric traumatic hip dislocations. The purpose of this systematic review is to evaluate the outcome relative frequency of dislocation direction, reduction type, and rate of APs for traumatic hip dislocations in the pediatric population.

METHODS

A systematic review on the topic of traumatic hip dislocations in the pediatric population was performed using PubMed, ScienceDirect, Web of Science, CINAHL, and MEDLINE databases from database inception to March 30, 2023. Inclusion criteria was full-text English articles, addressed traumatic hip dislocations, and pediatric patients (<18 y old).

RESULTS

A total of 24 articles (n=575 patients) met final inclusion criteria from a total of 219 articles retrieved from the initial search. For the average age of the included patients with reported age (n=433 patients), the frequency weighted mean was 9.50 years±1.75 years with a frequency weighted mean follow-up time of 74.05 months ±45.97 months (n=399 patients). The most common dislocation direction was posterior (86.4%), the most common treatment type was closed reduction (84.5%), AVN was the most common type of LTAEs (15.5% of APs), and labral/capsular injuries and acetabular fractures were the most common type of AIs (14.0% and 9.4% of APs, respectively). There were a combined total of 414 APs (72%) out of 575 total patients.

CONCLUSION

Pediatric traumatic hip dislocations are associated with a high rate of AIs and LTAEs (72%, 414 APs out of 575 patients). AVN, labral/capsular injuries, and acetabular fractures are the most common APs after pediatric traumatic hip dislocations. Pediatric hip dislocations are usually posterior and commonly managed through closed reduction.

LEVEL OF EVIDENCE

III, Systematic Review.

The Not-So-Merry-Go-Round: Traumatic Inferior-Anterior Hip Dislocation in a 9-Year-Old

Merry-go-rounds are not as innocuous as they may seem. Pediatric hip anterior-inferior dislocations are very rare and can be associated with low-energy trauma. Prompt recognition of pediatric hip dislocations is vital, and this should be treated as a time-sensitive orthopedic emergency. Closed reduction within 6 hours minimizes the risk of avascular necrosis (AVN). We present a case of a 9-year-old boy with an inferior-anterior hip dislocation following low energy trauma while playing on a merry-go-round. The patient was emergently brought to the theatre for closed reduction under general anesthesia within 6 hours. At his 12-month follow-up, he has a full range of motion without any pain.

Rare case of posterior hip dislocation caused by low-energy trauma in a boy in early adolescence: acute and long-term management-review of the literature

The incidence of hip dislocations in teenagers caused by low-velocity trauma is a relatively rare finding and constitutes a true orthopaedic emergency. Prompt reduction is recommended to avoid long-term complications. On average, the non-weight-bearing period ranges from 4 to 6 weeks. Follow-up with radiographic imaging is necessary to evaluate for hip pathologies over time. In this paper, we will report the findings of a posterior hip dislocation in a healthy boy in early adolescence caused by a ground level fall on grass with review of the literature. Closed reduction of the right hip was performed within 4 hours of the dislocation. A 6-week non-weight-bearing period was recommended before transitioning into a 2-week period of partial weight-bearing. At 12 weeks, our patient returned to sports and had negative radiographic and clinical findings of hip pathology throughout the follow-up period.

Recurrent traumatic hip dislocation in an 8-year-old boy

Pediatric traumatic hip dislocations (PTHD) are rare and represent around 5% of all pediatric dislocations. Associated bony or soft tissue injury can occur as often as 17%–25% of the time. We report a case of an 8-year-old boy presenting a posterior hip dislocation after a low-energy trauma, which was initially managed with closed reduction and bed rest for 1 week. Two days after hospital discharge, he suffered a recurrent posterior hip dislocation. He was now managed with 4 weeks of bed rest and lower limb skin traction followed by 1 week of no weight-bearing on crutches. With 6 months of follow-up, he is asymptomatic, walking autonomously, with complete and painless range of motion of the affected hip and no major radiographic changes. Pediatric traumatic hip dislocation is a rare and challenging injury that should be managed promptly. Currently, there is no protocol concerning treatment in the literature and its largely dependent of patient and parents' cooperation.

Traumatic Hip Dislocation in A Child Younger Than 3 Years- A rare Case Report And Review of Literature

INTRODUCTION

Hip dislocation in a child less than 3 years is a very rare event. Only a few case reports have been documented in Western literature. It is rarely reported from Indian population. Hip dislocations are mostly due to low velocity injury in children younger than 3 years. We report such a case of hip dislocation in a 2 year old child.

CASE REPORT

A 25 month old child presented to our casualty following a fall from a slide 3 hours prior to presentation. His right lower limb was adducted and internally rotated. There was severe pain on attempting movements. An X-ray of the pelvis was taken which showed a posterior hip dislocation on the right side. The child had an emergency closed reduction under general anaesthesia followed by a broom stick plaster cast with hips in 30° abduction. Congruency of reduction was checked with image intensifier before plaster application. The plaster was removed at 6 weeks and gradual weight bearing started. The child was reviewed at 6 and 18 months with MRI scans at 6 and 18 months. There were no signs of avascular necrosis or chondrolysis.

CONCLUSION

Paediatric hip dislocation (less than 3 years of age) is a very rare entity whose incidence is on the rise due to the increase in road traffic accidents. The key stone in proper management is clinical suspicion, early recognition and promptreduction (within 6 hours). Also gentle manipulation during reduction has a definite role in preventing iatrogenic chondrolysis and osteonecrosis of femoral head.