Session IV - Pediatrics

Saturday, October 18, 1997 Session IV, 9:47 a.m.

Traumatic Hip Dislocations in Children: Long-Term Follow-Up of Forty-four Patients

Charles T. Mehlman, DO, Gregory W. Hubbard, DO

Children's Hospital Medical Center, Cincinnati, Ohio, USA

Purpose: The purpose of this study was to analyze and characterize the long-term outcomes of children who suffer traumatic hip dislocation.

Methods: A computerized search identified 44 children who had been treated for unilateral traumatic hip dislocation between 1974 and 1996. Retrospective chart and x-ray review as well as telephone interviews were performed for all patients. Descriptive statistics and Fischer's exact test were used for data analysis.

Results: Thirty-five boys and 9 girls (avg. age 10 yrs 4 m) were evaluated at an average follow-up of 8 yrs 9 m (range 12 m-254 m). There were 43 posterior (30 - D11) and 1 anterior (30 - D10) hip dislocations. Six children (14%) had associated fractures about the hip (5 posterior wall acetabulum, 62 - A1.2, 1 femoral head osteochondral, 31 - C1.1) one of which required internal fixation. Ninety-three percent (41/44) of patients had their hips reduced 6 hrs. or less after injury. A concentric reduction was achieved in 89% (39/44) of cases. Of the 5 nonconcentric reductions, 3 were due to entrapped fracture fragments (requiring surgical treatment) and two were due to hemarthrosis. Post-reduction spica cast immobilization was utilized in younger patients and an early mobilization protocol in older patients. There were 4 cases of AVN (9%), 3 segmental without collapse and 1 with collapse. Three of these cases of AVN occurred despite reduction < 6 hrs. [p = 0.254]. Other complications included 1 recurrent dislocation, 1 sciatic neurapraxia, and 1 symptomatic heterotopic ossification requiring surgical removal.

Discussion and Conclusion: Spica cast treatment of younger children and early mobilization of older children were found to be effective treatments for traumatic hip dislocation in this study. Dislocation time > 6 hrs. was not found to be a reliable predictor of AVN.