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Updated: May 22, 2025
Imaging of the Microstructural Failure Mechanism in the Human Hip
Published on: September 29, 2023
Radiological, clinical and functional outcome of children with traumatic hip dislocation: a multicenter review of 66
Sara De Salvo1,2, Yunan Lu3, Liwei Shi4
1Department of Pediatric Orthopedic Surgery, Faculty of Medicine, Lille University Hospital, Av. Eugene Avinée, Lille, 59000, France.
Insights
Outcomes of pediatric post-traumatic hip dislocation (PHD) are worse with associated injuries like acetabular or proximal femoral fractures, high-energy trauma, and older age. Advanced imaging is crucial for timely diagnosis and favorable outcomes.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Radiology
Background:
- Limited understanding of pediatric post-traumatic hip dislocation (PHD) outcomes.
- PHD can be isolated or associated with acetabular (ACF) or proximal femoral fractures (PFF).
- Identifying risk factors for adverse outcomes is crucial.
Purpose of the Study:
- Evaluate radiologic, clinical, and functional outcomes of pediatric PHD.
- Assess outcomes in isolated PHD, PHD with ACF, and PHD with PFF.
- Identify risk factors associated with adverse outcomes in pediatric PHD.
Main Methods:
- Retrospective study of pediatric PHD patients across three institutions (01/2016-06/2023).
- Patients categorized into PHD, PHD with ACF, and PHD with PFF groups.
- Outcomes assessed via radiographs, Harris Hip Score (HHS), and avascular necrosis (AVN) criteria; risk factors analyzed.
Main Results:
- 66 pediatric PHD cases analyzed (mean age 10.7 years); 36.4% were ≤10 years old, 63.6% were >11 years old.
- Older patients (>11 years) more likely to experience high-energy trauma (p<0.05).
- Mean HHS scores were favorable (97.3 PHD, 93.8 ACF, 93.6 PFF); however, 33.3% of PFF patients developed AVN.
Conclusions:
- Adverse outcomes in pediatric PHD are linked to AVN from PFF, simultaneous ACF and PFF, misdiagnosed ACF, high-energy trauma, and older age.
- Advanced imaging (CT/MRI) is recommended to detect ACF in isolated dislocations.
- Timely diagnosis and treatment are essential for favorable pediatric PHD outcomes.
Introduction:
Current understanding of the outcomes of post-traumatic hip dislocation (PHD) in pediatric patients is limited. The purpose of this study is to evaluate the radiologic, clinical, and functional outcomes of patients with PHD, whether isolated or associated with acetabular (ACF) or proximal femoral fractures (PFF), and to identify potential risk factors for adverse outcomes.
Methods:
This is a retrospective study of pediatric patients with PHD who were consecutively enrolled at three different institutions between 01/2016 and 06/2023. Patients were divided into three groups: PHD (PHD group), PHD with ACF (ACF group), and PHD with PFF (PFF group). Standard radiographs were used to classify each PHD and to identify the presence of other associated bone lesions. Clinical and functional outcomes were assessed using the Harris Hip Score (HHS). Avascular necrosis (AVN) was determined according to the Ratliff criteria. The association between outcome and associated injuries, age at trauma (≤ 10 versus > 11 years), traumatic mechanism (low versus high energy), reduction type (open versus closed), and direction of dislocation (posterior versus anterior) was evaluated.
Results:
Sixty-six cases of unilateral PHD (63 posterior and 3 anterior) were analyzed, consisting of 43 males and 23 females with a mean age of 10.7 years (1-18). Of these, 24 patients were ≤ 10 years old (36.4%), 16 of whom (66.7%) had low-energy trauma. Meanwhile, 42 patients were > 11 years old (63.6%), of which 26 had high-energy trauma (61.9%; p < 0.05). It was observed that patients in the PHD group were significantly younger than those in the ACF and PFF groups (p < 0.05). ACF group had 2/25 patients with misdiagnosed ACF > 3 weeks after injury (8%) and 3/25 with concomitant ACF and PFF (12%), and PFF group had 4/12 patients with AVN (33.3%). Most patients had a favorable mean HHS score, being 97.3 for the PHD group, 93.8 for the ACF group, and 93.6 for the PFF group.
Conclusion:
The outcome of PHD is worse in patients with AVN secondary to PFF, simultaneous ACF and PFF, misdiagnosed ACF, high-energy trauma, and older age at the time of injury. Advanced imaging, such as CT scan or MRI is necessary to rule out ACF in isolated dislocations. Timely diagnosis and treatment of these lesions usually result in a favorable outcome.
Level Of Evidence:
III.
