Paediatric Orthopaedic Department, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
Paediatric Orthopaedic Department, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
Injury. 2021 Dec;52(12):3660-3665. doi: 10.1016/j.injury.2021.04.010. Epub 2021 Apr 7.
Traumatic hip dislocation is a rare injury in the paediatric population. It can occur after high energy trauma, but also after lower energy injuries especially in younger children. Posterior dislocation is the most common pattern of hip dislocation. In most cases, closed reduction is successful, but occasionally open reduction is required to achieve concentric reduction. The aim of our study was to present the 10-year experience from a Level-1 Trauma Paediatric Hospital and to comment on how our experience correlates with the current literature.
This is a retrospective case series of all paediatric patients (< 16 years old) with a traumatic hip dislocation presented and/or treated at our institution, between the 1 of January 2010 and 31 August 2020.
Thirteen cases of traumatic hip dislocation were identified. There were 7 females. The mean age was 9.8 years. Typically, younger patients were involved in lower energy injuries. The direction of hip dislocation was posterior in ten cases. Associated injuries were seen in eight patients. All cases underwent closed reduction, which was successful in nine cases. Mean time to reduction was 6.8 hours. Post reduction imaging with CT and/or MRI was performed in all cases. There was residual subluxation in three cases, requiring open reduction. In one case with unrecognised undisplaced physeal injury, closed reduction resulted in a Delbet type 1 hip fracture. Two cases developed avascular necrosis (AVN).
Traumatic paediatric hip dislocation is a rare injury. A target of 6 hours for reduction should be employed as this will reduce the risk of AVN in those who have not permanently damaged the vessels at the time of injury. We advocate all attempts for closed reduction to be performed in an operating theatre with the use of an image intensifier to help identifying associated injuries and confirm concentric reduction. If closed reduction fails, open reduction is required. Post-reduction MRI is an important adjunct to recognise associated soft tissue injuries. Follow up of patients should continue for 2 years as a minimum to help detect AVN.
创伤性髋关节脱位在儿科人群中较为少见。它可由高能创伤引起，但也可由低能损伤引起，尤其是在年幼的儿童中。后脱位是髋关节脱位最常见的类型。在大多数情况下，闭合复位是成功的，但偶尔需要切开复位以实现同心复位。我们的研究目的是介绍一家 1 级创伤儿科医院的 10 年经验，并对我们的经验与当前文献的相关性进行评论。
这是一项回顾性病例系列研究，纳入了 2010 年 1 月 1 日至 2020 年 8 月 31 日期间在我们机构就诊或治疗的所有创伤性髋关节脱位的儿童(<16 岁)患者。
共发现 13 例创伤性髋关节脱位患者，其中 7 例为女性，平均年龄为 9.8 岁。通常，年轻患者更易发生低能损伤。10 例髋关节脱位的方向为后脱位。8 例患者存在合并损伤。所有病例均行闭合复位，其中 9 例复位成功。平均复位时间为 6.8 小时。所有病例均行 CT 和/或 MRI 检查。3 例存在残余半脱位，需行切开复位。1 例因未识别的骺板未移位损伤，闭合复位导致 Delbet 1 型髋关节骨折。2 例发生股骨头缺血性坏死（AVN）。
创伤性小儿髋关节脱位是一种罕见的损伤。应采用 6 小时复位的目标，因为这将降低未永久性损伤血管的患者发生 AVN 的风险。我们主张在手术室中进行所有闭合复位尝试，并使用影像增强器帮助识别合并损伤并确认同心复位。如果闭合复位失败，需要切开复位。复位后 MRI 是识别相关软组织损伤的重要辅助手段。患者的随访应至少持续 2 年，以帮助发现 AVN。
