Emergency department diagnosis and treatment of traumatic hip dislocations in children under the age of 7 years: a 10-year review
- 1Department of Women's and Children's Health, Division of Pediatric Emergency Medicine, University of Padova, Padova, Italy
- 2Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- 3Pediatric Emergency Department, Rappaport Faculty of Medicine, Rambam Health Care Campus, Technion University, Haifa, Israel
- Correspondence to Dr Silvia Bressan, Department of Women's and Children's Health, Division of Pediatric Emergency Medicine, University of Padova, Via Giustiniani 3, Padova 35128, Italy;
- Received 8 September 2012
- Revised 23 November 2012
- Accepted 13 February 2013
- Published Online First 7 March 2013
Background and aims Traumatic hip dislocations (THD) are uncommon in children. They constitute true emergencies because unrecognised THD leads to avascular necrosis (AVN) of the femoral head. This review presents the evidence for best practice for the diagnosis and treatment of THD in the emergency department (ED) of children under the age of 7 years.
Methods Searches for the period 2002–2012 were performed in PubMED, Cochrane database, EMBASE, Google Scholar and hand search.
Results Twenty-five case reports and case series articles were identified, 53 described children with acute and 23 with neglected THD. Overall, 42 (55%) were male and 73 (96%) sustained a posterior dislocation. Forty-eight (63%) had THD following a low-energy trauma. Eight (11%) reported associated injuries. Twenty-one (39.6%) acute dislocations were reduced in the ED without complications. AVN was identified in 3 (5.7%) children, who underwent reduction ≥10 h after dislocation. Redislocation occurred in 3 (5.7%) children and coxa magna developed in 5 (9.4%). Long-term functional outcome of 42 patients resulted in full recovery, and it was fair to good in 3 (including 2 children with AVN). All neglected cases (≥4 weeks from trauma) needed open reduction in the operating room (OR). AVN was identified in 11 children (47.8%). Hip function was completely recovered in 16 (70%) patients.
Conclusions THD in this age group mainly occurs with low-energy trauma and leads to posterior dislocations. Urgent closed reduction of acute cases are done in the OR, or the ED. ED reduction appears to be safe. Neglected THDs need open reduction.