Dislocation Of Hip In Children Research Articles

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

Traumatic hip dislocation in children has a relatively rare occurrence. There are some residual complications, such as avascular necrosis of the femoral head, growth disturbance caused by premature fusion, neurological injury, recurrent dislocation, and posttraumatic arthritis. There is no consensus in the literature about the period of non-weight bearing after reduction. A rare case of a 13-year-old boy of hip dislocation caused by trivial force for age is reported followed by review of the pediatric literatures with treatment recommendation.

Traumatic posterior hip dislocation in a child

Traumatic hip dislocation in children is an uncommon injury and constitutes an orthopedic emergency. We herein present a traumatic posterior dislocation of the hip in a 4-year-old child and emphasize on the role of early correction of the injury, preferably within 6 h since its occurrence to prevent long-term complications such as osteonecrosis, coxa magna, and osteoarthritis.

Outcome of traumatic hip dislocation in children

We reviewed 13 patients without an underlying syndrome with traumatic hip dislocation between 3 and 10 years of age (mean 4.8 years) at the time of injury. The final reviews were between 1 and 11 years (mean 6 years). All children had posterior dislocation, except one, who had an anterior dislocation. Time taken from trauma to reduction was less than 6 h in three patients, 6 h to 1 day in two patients, 1 day to 3 weeks in seven patients, and 4 weeks in one. All of them underwent closed reduction, except two, who required open reduction through a posterior approach. All patients had excellent hip function and radiographic result on the basis of Garret classification, except for one with limping at 4 years after trauma. The patients treated with hip spica after reduction (10 patients) did not have recurrent dislocation whereas two out of three patients who were treated without postreduction hip spica developed recurrent dislocation. One out of 13 patients without an underlying syndrome and a 6-year-old patient with Down syndrome with neglected hip dislocation and radiological avascular necrosis at presentation recovered with congruent hip following a complete and maintained reduction. This case series suggested that closed reduction was possible for cases of neglected hip dislocation for up to 3 weeks. Open reduction through the posterior approach was safe in neglected irreducible posterior hip dislocation. Those hips that underwent complete reduction and were maintained reduced with hip spica had an excellent functional outcome even in the presence of avascular necrosis. This is a level IV study.

Missed Pediatric Traumatic Hip Dislocation: A Case Report.

While traumatic hip dislocation is an uncommon injury in children, it is believed that urgent reduction within six hours of injury reduces the risk of osteonecrosis of the femoral head1. Mehlman et al. reported that there is a twentyfold increased risk of osteonecrosis, which becomes radiographically apparent within twelve months after dislocation, when reduction takes place more than six hours after injury2. Reduction should be performed with caution; adequate muscle relaxation is important because there is increased risk of femoral epiphysis displacement or epiphysiolysis without anesthesia3. Postreduction radiographs should be critically analyzed for concentric reduction since subtle incongruence often reflects entrapped soft tissue and the need for open reduction. Coxa magna is a common late radiographic finding that occurs more frequently in children younger than ten years old and is not associated with functional limitation; however, osteonecrosis and osteoarthritis have clinical sequelae4. In Barquet’s retrospective review of 145 cases of traumatic hip dislocations in children, 92% had radiographic evidence of osteonecrosis at the two-year follow-up5. He compared the presentation of osteonecrosis with Legg-Calve-Perthes disease even though the retrospective review of radiographs alone does not include the total time spent dislocated5. Table I provides details of Barquet’s radiograph-based osteonecrosis classification following pediatric traumatic hip dislocations5. Barquet reported three cases of neglected (>40 hours) hip dislocation with osteonecrosis of the femoral head at five, nineteen, and twenty months after injury6. Banskota et al. reported the follow-up of neglected (mean delay, twelve months) traumatic hip dislocations in eight children, all of whom were treated with open reduction; all had evidence of osteonecrosis at the time of follow-up (mean, seven years)7. Kumar and Jain reported neglected (mean delay, sixteen weeks) traumatic Epstein type-I hip dislocations, all …

Traumatic hip dislocation in children

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.

Unilateral varus osteotomy of the proximal femur in children with cerebral palsy: A five-year follow-up of the development of both hips

Varus osteotomy of the proximal femur (VOPF) is one treatment option to prevent hip dislocation in children with cerebral palsy (CP). It is questioned whether the osteotomy should be performed in the displaced hip only, or if it should be performed bilaterally to prevent later displacement of the contralateral hip. CPUP is a register and healthcare programme for children with CP that was initiated in 1994 in southern Sweden. In the programme, range-of-motion and radiographic examination of the hips is performed regularly. These data have been analysed preoperatively and for 5years postoperatively in children treated with unilateral VOPF. Children with CP living in the counties of Skåne and Blekinge in the south of Sweden, who were treated with unilateral VOPF at least 5years ago, were included in the study. The degree of hip displacement and the range of hip motion were analysed preoperatively and after 5years. Repeat hip operations after the index operation were recorded. Twenty-four children fulfilled the inclusion criteria. Mean age at index operation was 7.6 (2.8-13.2) years. No child died within 5years postoperatively, and no child was lost from follow-up. At follow-up after 5years, 2 of the 24 children had been operated on with VOPF in the contralateral hip. The range of motion in both hips decreased, but the difference between the index hip and the contralateral hip did not change significantly. Children with CP and unilateral hip displacement have a low risk of later contralateral displacement after being operated on with unilateral VOPF. This supports healthcare programmes that advocate unilateral VOPF in children with unilateral hip displacement.

Traumatic anterior dislocation of hip in a teenager: an open unusual type.

Traumatic anterior open dislocation of hip is rare in children and prone to be associated with injuries, extensive soft tissue damage and avascular necrosis of the femoral head. We report a hitherto undescribed anterior open dislocation of the hip joint in a 14-year-old boy. The dislocated head finished up in the contralateral obturator foramen. The management of the case and its relation to published classifications of anterior hip dislocations in children are discussed.

Utility of magnetic resonance imaging (MRI) after closed reduction of developmental dysplasia of the hip

Magnetic resonance imaging (MRI) has been successfully used in the determination of the adequacy of the surgical reduction of congenitally dislocated hips in children. We present the results of a prospective series of patients treated conservatively. MRI was performed in all hips after positioning was deemed adequate on radiographs after spica cast application. The goal of this study was to evaluate the usefulness of MRI in this indication. After the study was approved by our local ethics committee, 31 patients for a total of 36 dislocated hips were included. After the traction period, hip testing was performed and a hip spica cast was applied under general anaesthesia. All children had MRI within 1week of reduction, without the need for contention or general anaesthesia. Hip reduction was assessed on axial and coronal MRI images. The concentric reduction of the hip was confirmed in 30 cases out of 36. In three cases, the dislocation was retrospectively suspected on radiographs and then confirmed. In the three remaining cases, hip dislocation was only diagnosed on MRI. MRI screening of congenitally dislocated hips after reduction procedures is a safe and reliable procedure to assess the concentric reduction of the hip. Even in doubtful cases, MRI detected persistent hip dislocations and was conducive to iterative reduction and satisfactory outcome and result.

A hip resurfacing implant in an adolescent with cerebral palsy

Pain or skin irritation due to the femoral stump after proximal femoral resection for chronic spastic hip dislocation in children with severe cerebral palsy may be encountered. We describe a technique that, to our knowledge, has been unreported earlier and can deal with this phenomenon to improve the patient's comfort level and help the patient to sit more comfortably.

Prevalence of hip dislocation among children with cerebral palsy in regions with and without a surveillance programme: a cross sectional study in Sweden and Norway

BackgroundHip dislocation is a serious complication among children with cerebral palsy (CP). The aim of this study was to compare the prevalence of hip dislocation among children with CP in an area providing regular care with an area providing hip surveillance services.MethodsThis is a cross-sectional study in seven Norwegian counties providing regular care and one Swedish healthcare region where a hip surveillance programme was introduced in 1994. Data were provided by the Norwegian Cerebral Palsy Register and the CP Register in Southern Sweden. Children born 1996 - 2003 with moderate to severe CP, defined as Gross Motor Classification System (GMFCS) levels III - V, were included. In all, 119 Norwegian and 136 Swedish children fulfilled the criteria. In Norway, data on hip operations and radiographs of the hips were collected from medical records, while these data are collected routinely in the Swedish register. The hip migration percentage was measured on the recent radiographs. Hip dislocation was defined as a migration percent of 100%.ResultsThe proportion of children at GMFCS levels III - V was 34% in the Norwegian and 38% in the Swedish population. In the Norwegian population, hip dislocation was diagnosed in 18 children (15.1%; CI: 9.8 - 22.6) compared with only one child (0.7%; 95% CI: 0.01 - 4.0) in Southern Sweden (p = < 0.001). Hip surgery was performed in 53 (44.5%) of the Norwegian children and in 43 (32%) of the Swedish children (p = 0.03). The total number of hip operations was 65 in Norway and 63 in Sweden. Norwegian children were first operated at a mean age of 7.6 years (SD: 2.9) compared with 5.7 years (SD: 2.3) in Sweden (p = 0.001).ConclusionsThe surveillance programme reduced the number of hip dislocations and the proportion of children undergoing hip surgery was lower. However, with the surveillance programme the first operation was performed at a younger age. Our results strongly support the effectiveness of a specifically designed follow-up programme for the prevention of hip dislocation in children with CP.

Papel de la toxina botulínica tipo A en la prevención de la luxación de cadera en niños con parálisis cerebral

Aims To determine the effect of treatment with botulinum toxin type-A (BoNT A) on hip abduction capacity, adductor muscle tone and prevention of hip dislocation in children with cerebral palsy (CP). Methods Preliminary prospective study of 10 patients (20 hips) treated with BoNT A (Botox ®). Articular abduction mobility, hip flexion and spasticity at pre-treatment and 1, 3 and 6 months post-treatment were assessed. Reimer Migration Index (RMI) was also evaluated at pre-treatment and 3 months post-treatment. Results Six males and four females were included in the study. Eight children had spastic diparesis and two had spastic tetraparesis. Mean age was 5.5 ± 2.27 (range 2-9) years. Improvements were detected following BoNT A treatment in hip flexion and muscle tone and a reduction in RMI was observed. Conclusions BoNT A treatment is effective in reducing muscle tone and detaining the progression of hip dislocation.

Septic hip dislocations in children in a developing country

To report on a radiological issue and therapeutic aspects encountered in septic hip dislocations in a developing country. Nineteen children among whom 11 boys and 8 girls aged on average 5.3-years old presented 7 recent and 12 late hip dislocations. Those dislocations were distributed into in category 1: dislocations without associated lesion; category 2: dislocations associated with minor lesions; category 3: dislocations associated with major lesion. Ten children who presented an elevated erythrocyte sedimentation rate (ESR) received antibiotics. An arthrotomy was performed in children with a recent dislocation. Traction was performed in all children with an average duration of 5 weeks. The results were considered good, intermediate or bad using two parameters: ESR and reduction of dislocation. 2 category 1 dislocations, 6 category 2 dislocations and 11 category 3 dislocations were noted. As concerns the recent dislocations, there were 2 category 1 dislocations and 5 category 2 dislocations. For late dislocations, 1 category 2 and 11 category 3 dislocations were recorded. There were 8 good results and 11 bad results. The good results concerned 7 recent dislocations and one late dislocation. The bad results concerned exclusively late dislocations. In children with septic hip dislocations, the good results concern almost exclusively recent dislocations but arthrotomy and immobilization must be done early.

Diagnostic Value of Contrast Radiologic Examination for Rational Planning of Surgical Treatment of High Congenital Hip Dislocation in Children

Diagnostic value of contrast radiologic examination of hip joint was analyzed in 49 children aged from 1 to 12 years with high congenital hip dislocation. Informativeness of 38 standard hip joint arthrograms was studied for the choice of treatment technique and preoperative planning. It was stated that arthrography did not provide sufficient information on the changes in soft tissue and cartilaginous structures of the joint. Experience in joint pathologic changes diagnosis using contrast computed tomography (11 patients) was presented. Potentialities of that examination technique were determined. It was shown that in high dislocation of femoral head it provided real picture of interrelation of all articular structures. That enabled to take objectively substantiated decision on open or closed correction of dislocation and perform an adequate preoperative planning.

Traumatic Hip Dislocation in Childhood

We report the outcome of closed reduction of traumatic hip dislocation in 28 children younger than 16 years of age (average age, 8 years 10 months). At an average follow-up of 8 years and 10 months (range, 2 years - 42 years), 18 patients were asymptomatic and enjoying a normal life, and some of them returned to practice sport activities. The remainder had complications related to associated injuries. There were no cases of avascular necrosis of the femoral head during follow-up. The majority of dislocations were attributable to low energy injuries in children younger than 10 years of age. Traumatic hip dislocation in children is uncommon. Management after reduction is not clearly defined in the literature. It is important to perform reduction as soon as possible to avoid later avascular necrosis.

Effects of standing on bone density and hip dislocation in children with severe cerebral palsy

AbstractThe aim of the study was to evaluate whether standing time associates with bone density and/or hip dislocation in children with severe cerebral palsy. The study design was cross-sectional and descriptive. Eleven boys and seven girls, median age 10.5 years, with severe cerebral palsy participated. Spasticity was measured with modified Ashworth scale. Seven children had scores of 0–1, and 11 had scores of 2–4. Eight of 18 had insulin-like growth factor-I levels lower than −2 standard deviations below the age-matched mean. Time spent in the Standing shell was recorded. Bone mineral density levels determined using dual energy X-ray absorptiometry and hip X-ray were evaluated. Time spent in the Standing shell was 40 min/day (range=4–164). The lumbar spine bone mineral density was 73% of that of age-matched able-bodied controls. Standing time was not associated with bone mineral density, but in 11 children with modified Ashworth scale scores of 2–4, standing time was significantly and negatively associa...

Surgical Treatment of Developmental Hip Dislocation in Children Aged 1 to 3 Years: A Mean 18-Year, 9-Month Follow-up Study

Forty-six consecutive patients with 57 congenitally dislocated hips were treated with open reduction and femoral or acetabular procedures as indicated. Patient age ranged from 12 to 36 months at the time of surgery. We evaluated the outcome of 38 of the 46 patients (83%) with 47 hips (83%) at a mean follow-up of 18 years, 9 months (range, 13 years, 7 months to 24 years, 7 months) after all patients had reached skeletal maturity.Using Severin's radiographic classification, 24 hips (52%) were rated as class I, 12 (26%) as class II, 8 (17%) as class III, 2 (4%) as class IV, and 0 as class V. The mean Iowa Hip Score was 92 points. One patient had significant abductor weakness and a Trendelenburg gait. The mean leg-length discrepancy was <1 cm. Disturbance in growth of the proximal aspect of the femur occurred in 10 hips (22%).In our experience, open reduction of the congenitally dislocated hip in children aged 1 to 3 years, combined with femoral or acetabular procedures, leads to successful clinical and radiographic results in most cases. These patients have an opportunity for normal hip function during childhood and the potential for a straightforward reconstructive procedure should they develop severe degenerative hip arthrosis.

Surgical treatment of developmental hip dislocation in children aged 1 to 3 years

Surgical treatment of developmental hip dislocation in children aged 1 to 3 years

Traumatic Hip Dislocations in Children and Adolescents: Pitfalls and Complications

Traumatic hip dislocation is an uncommon injury in children. Lack of familiarity with management of the treating physician may lead to complications. Hip dislocation in young children can occur with minor trauma; in adolescents, greater force is required to produce a traumatic complete hip dislocation. Transient hip dislocation with spontaneous but incomplete reduction is a diagnostic pitfall that can occur in adolescents. Any asymmetric widening of the hip joint warrants additional investigation. Most dislocations in children can be reduced with gentle manipulation. Urgent reduction of the hip within 6 hours of injury reduces the risk of osteonecrosis. However, closed reduction in adolescents should be performed with caution because of the risk of displacement of the femoral head during manipulation. Open reduction is indicated when closed reduction fails or when there is interposition of bone or soft tissue following attempted closed reduction. Late complications include osteonecrosis, coxa magna, and osteoarthritis.

“Postural Management” to Prevent Hip Dislocation in Children with Cerebral Palsy

Muscolo-skeletal disorders and hip deformity play a key role on future development of motor and adaptive functions in children with cerebral palsy (CP). Lateral migration of the femoral head increases on average 7.7% per year and may progress in association with acetabular dysplasia to hip dislocation. Conservative preservation of muscle length and balance may prevent or reduce femoral head migration and acetabular dysplasia. Equipment for position lying, sitting, and standing is an established method of maintaining muscle length and joint range. French approach (Le Métayer et al) include the use of customised plaster cast orthoses, for sitting and standing positions, called siège moulé and gouttière, tailor-made according to the child's muscolo-skeletal characteristics and motor abilities. At our department, hips with clinical and radiological evidence of displacement unresponsive to pharmacological and surgical treatment were treated with postural management. The two cases we show in this paper underwent a physiotherapy programme (neurodevelopment treatment) twice a week and a seated postural programme 5 hours a day with the siège moulé. Hip radiographs were measured with the migration percentage (MP) described by Reimers. The follow-up measurements showed a progressive reduction of MP values of the hip treated, confirming the significant benefit from the combined non surgical approach. The study supports the evidence that conservative management of hip deformity with siège moulé can be successful if implemented before the development of hip dysplasia.

Redislocation after treatment of traumatic dislocation of hip in children: a report of two cases and literature review

From August 1998 to June 2005, we treated five children (age range 2-9 years) with traumatic dislocation of hip. The mean follow-up period was 4.1 years (range 1-8 years). There was acceptable reduction in all cases by single attempt at closed reduction. Two patients aged 2 and 3 years, respectively, had redislocation. Other complications like nerve injuries, avascular necrosis, growth disturbance, ectopic ossification and post-traumatic arthritis were not seen till the last follow-up (mean 4.1; range 1-8 years). Closed reduction is an effective treatment method for traumatic dislocation of hip in children, but adequate immobilization and protection from weight bearing is needed in children aged less than 10 years to prevent redislocation.