Traumatic hip dislocation in children

Abstract

The aim of this study was to evaluate the outcomes of reduction in the treatment of traumatic posterior hip dislocation in children. Data of 22 pediatric patients (22 hips) with traumatic hip dislocation from January 1995 to December 2007 were analyzed. The clinical evaluation focused on symptoms, physical findings, and range of motion. Radiographs identified the type of hip dislocation. The hip dislocation classification was based on Thompson and Epstein. The reduction procedure was performed according to three variants: variant 1, closed reduction; variant 2, release of the adductor longus, lengthening of the psoas tendon, and insertion of a Kirschner wire through the femoral head into the acetabulum; and variant 3, removal of the soft-tissue interposition of the hip. After reduction, radiography was used to determine whether the hip is concentric and to check whether any other injuries might have been caused after manipulation. There were six females (27.3%) and 16 males (72.7%) in this study. All had type I posterior dislocation of the hip. The ages of the patients at diagnosis ranged from 3 years, 2 months to 9 years, 10 months. The reduction procedure was performed according to variant 1 in 16, variant 2 in five, and variant 3 in one. We attained excellent results in eight hips (36.4%), good results in seven hips (31.8%), fair results in four hips (18.2%), and poor results in three hips (13.6%). There was avascular necrosis in three hips (13.6%), coxa magna in two hips (9.1%), deficient limb of 2 cm in two hips (9.1%), and a limp in two hips (9.1%). The hip scores were 82.4 points on average (range 62-100). Children with traumatic hip dislocation should undergo reduction as soon as possible. If the interval from injury to reduction exceeds 3 weeks, we suggest that the surgeon release the adductor longus, lengthen the psoas tendon, and insert a Kirschner wire. This simple and safe surgical procedure results in marked improvement in hip function and prevents complications later.