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Traumatic hip dislocation in children. Long-term followup of 42 patients
C T Mehlman1, G W Hubbard, A H Crawford
1University of Cincinnati College of Medicine, Division of Pediatric Orthopaedic Surgery, Children's Hospital Medical Center, OH 45229-3039, USA.
Insights
Prompt hip dislocations in children can lead to avascular necrosis, especially if reduction is delayed over 6 hours. Early intervention improves outcomes, allowing most young patients to remain active.
Area of Science:
- Orthopedic Surgery
- Pediatric Traumatology
Background:
- Traumatic hip dislocations are uncommon in children.
- Understanding long-term outcomes and risk factors is crucial for pediatric patients.
Purpose of the Study:
- To evaluate the impact of traumatic hip dislocations in skeletally immature patients.
- To identify risk factors for avascular necrosis and assess functional outcomes.
Main Methods:
- Retrospective study of 42 pediatric patients (under 16) with hip dislocations.
- Data collected via charts, radiographs, and questionnaires.
- Average follow-up of 10 years.
Main Results:
- 64% of dislocations resulted from low-energy injuries.
- Avascular necrosis occurred in 12% of patients.
- Delayed reduction (>6 hours) increased avascular necrosis risk 20-fold.
- Computed tomography recommended for joint asymmetry ≥3 mm.
- 95% reported mild or no pain; 95% had mild or no limp.
- 78% returned to high-demand activities.
Conclusions:
- Timely hip reduction is critical to prevent avascular necrosis in children.
- Most pediatric patients achieve good functional outcomes after traumatic hip dislocation.
- Imaging and management protocols can be refined based on these findings.
Abstract:
To assess the impact of traumatic hip dislocations in the skeletally immature patient, 42 children younger than 16 years of age (average age, 9 years 10 months) who were treated at the authors' institution were studied. Data were collected from charts and radiographs and by completion of questionnaires. The average followup after injury was 10 years 1 month. The majority of dislocations (64%) were attributable to low energy injuries. Ipsilateral fractures about the hip occurred in 17% of patients. Avascular necrosis of the femoral head developed in 12% of patients, with the amount of time spent dislocated being the only statistically proven risk factor. Patients whose reduction was delayed greater than 6 hours had a 20 times higher risk of having avascular necrosis develop compared with patients whose hips were reduced in 6 hours or less. The use of computed tomography for joint asymmetry of 3 mm or greater and omission of bone scan screening were supported by this study. Functional outcomes were very good in this series with 95% of patients suffering mild (usually weather related) or no pain and 95% of patients suffering mild pain (intermittently noticeable) or no limp. A large percentage of the patients (78%) continued to participate in high demand activities such as football, soccer, and basketball.
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