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Delayed diagnosis of traumatic hip dislocation mimicking Perthes disease in a child
Rohit Singhal1, Daniel Perry, Daniel Cohen
1Department of Trauma and Orthopaedics, Leighton Hospital, Crewe, UK. singhal.rohit75@gmail.com
Insights
Traumatic hip dislocations in children, though rare, can result from minor injuries. Early reduction is crucial to prevent avascular necrosis (AVN), with delayed treatment significantly increasing risks.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Pediatric Radiology
Background:
- Traumatic hip dislocations are infrequent in children but can arise from seemingly minor incidents.
- Prompt reduction of hip dislocations is vital, as the risk of avascular necrosis (AVN) escalates dramatically with delayed treatment.
Observation:
- A 5-year-old boy experienced a hip dislocation following a trivial trauma.
- The patient presented with knee pain, a potential indicator of referred hip pathology.
- The mechanism of injury was relatively minor, underscoring that significant trauma is not always required for pediatric hip dislocation.
Findings:
- Avascular necrosis (AVN) incidence increases from 3-6% within 4 hours to 66% after 24 hours post-dislocation.
- Traumatic AVN in children shares similarities with Perthes disease in its clinical course.
- Effective management of traumatic AVN necessitates strategies for acetabular containment, similar to Perthes disease treatment.
Implications:
- Highlights the importance of considering hip dislocation in pediatric patients, even with minimal trauma history.
- Emphasizes that knee pain can be an atypical presentation of hip pathology in children.
- Suggests that management protocols for traumatic AVN should mirror those for Perthes disease, focusing on joint stability and containment.
Abstract:
Traumatic hip dislocations in children are uncommon, yet even trivial injuries may result in dislocation. Avascular necrosis (AVN) occurs in 3-6% of dislocations if reduction is performed within the first 4 h, however, the incidence rises to 66% if the reduction is performed 24 h after dislocation. Awareness and early identification is therefore critical to long term prognosis. The authors report a case of a relatively trivial trauma resulting in hip dislocation in a 5-year-old boy. This case is useful in highlighting that (a) hip dislocation may occur in children with relatively trivial mechanisms, (b) knee pain often indicates an underlying hip pathology and (c) traumatic AVN follows a similar course to Perthes disease and therefore may be management should be tailored in a similar manner to achieve containment within the acetabulum.
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