Traumatic Hip Dislocations

in Children and
Adolescents: Pitfalls and
Complications
Abstract
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.
T
raumatic hip dislocation is an
uncommon injury in children.
Several reports have indicated that
timely and appropriate manage-
ment may improve outcomes and
reduce the risk of complications.
1-8
Adverse outcomes and complica-
tions may result from lack of famil-
iarity with this injury and/or from
failure to recognize and address cer-
tain pitfalls in diagnosis and early
management.
Pathophysiology and
Principles of Initial
Management
The force required to cause a hip dis-
location increases with age. Thus,
minor trauma before age 10 years
may produce a dislocation, while
high-energy trauma is more com-
monly seen as the cause of disloca-
tion after age 12 years.
3
This differ-
ence in mode of injury is attributable
to the laxity of the periacetabular
structures found in younger persons.
During adolescence, the acetabu-
lum and femoral head become more
rigid, and injury patterns are simi-
lar to those seen in adults, with the
exception that the growth plate
may be damaged at the time of
dislocation.
9-11
The relative laxity in
young children also may account for
the low incidence of acetabular or
femoral head fracture in this popu-
lation.
3
Jos A. Herrera-Soto, MD
Charles T. Price, MD
Dr. Herrera-Soto is Assistant Program
Director, Pediatric Orthopaedic
Fellowship Program and Director of
Orthopaedic Research, Orlando
Regional Medical Center, Orlando, FL.
Dr. Price is Program Director, Pediatric
Orthopaedic Fellowship, Orlando
Regional Medical Center.
None of the following authors or a
member of their immediate families has
received anything of value from or owns
stock in a commercial company or
institution related directly or indirectly to
the subject of this article: Dr. Herrera-
Soto and Dr. Price.
Reprint requests: Dr. Herrera-Soto,
Pediatric Orthopaedic Fellowship
Program, Orlando Regional Medical
Center, 83 West Columbia Street,
Orlando, FL 32806.
J Am Acad Orthop Surg 2009;17:
15-21
Copyright 2009 by the American
Academy of Orthopaedic Surgeons.
Volume 17, Number 1, January 2009 15
Femoral head dislocations can be
anterior or posterior.
12
As in adults,
90% to 95% of hip dislocations in
children are posterior.
2,3,13
Anterior
and inferior dislocations are rare.
Any abnormal extremity position
should raise the suspicion of a hip
dislocation. The position of the low-
er limb when first examined in the
emergency department will indicate
the direction of the dislocation. Pos-
terior dislocations are characterized
by hip flexion, adduction, and inter-
nal rotation. Anterior dislocations
are indicated by hip extension, ab-
duction, and external rotation. In in-
ferior dislocations, the thigh is hy-
perflexed or abducted and resting on
or alongside the abdomen with the
knee flexed. Neurovascular exami-
nation should be performed to iden-
tify any associated injuries, and plain
radiographs should be obtained be-
fore reduction is attempted.
Prompt closed reduction with ap-
propriate sedation in the emergency
department is recommended for
most hip dislocations in children.
However, caution with this ap-
proach is recommended for adoles-
cents and for patients with associat-
ed injuries such as femoral head
displacement, physeal injury, ace-
tabular fracture, or labral interposi-
tion. Reduction within 6 hours is
recommended to minimize the risk
of osteonecrosis.
2,8
Mehlman et al
2
and Kutty et al
8
noted a 20-fold in-
crease in osteonecrosis when reduc-
tion was delayed beyond 6 hours in
children and adolescents.
Most hip dislocations in children
are resolved easily with gentle trac-
tion.
3
When one or two gentle at-
tempts at closed reduction are un-
successful, open reduction under
general anesthesia is recommended.
Open reduction is also indicated
when reduction is incomplete be-
cause of the presence of interposed
bone or soft tissue. The surgical ap-
proach should be from the direction
of the dislocation. Thus, anterior
dislocations should be approached
anteriorly and posterior dislocations
posteriorly to preserve maximum
vascularity and to repair defects in
the bone or joint capsule.
Immobilization in a spica cast or
bed rest with abduction splinting for
3 to 4 weeks is recommended for chil-
dren younger than age 10 years; older
children and adolescents are treated
withprotected weight bearing for 6 to
12 weeks. With appropriate manage-
ment, most children with traumatic
hip dislocation will have an excellent
outcome,
2,3,14,15
but there are numer-
ous pitfalls and potential complica-
tions that can occur in certain cir-
cumstances.
Pitfalls
Unrecognized Incongruous
Reduction
Children younger than age 10
years who have incurred a hip dislo-
cation caused by minor trauma com-
monly report popping or a shifting
sensation of the hip. Closed reduc-
tion may be easily performed, but
cartilage or capsular interposition
may prevent congruous reduc-
tion.
3,16
Interposition will be evident
on an anteroposterior radiograph of
the pelvis as a reduced hip with joint
space widening. Although up to 3
mm of hip joint asymmetry may be
attributable to hematoma or joint
laxity, one should not assume that
either is the cause of minor asym-
metry.
2,3,16
Loose osteocartilaginous
fragments may go unnoticed because
of incomplete ossification of an ace-
tabular or femoral head fragment.
An entrapped labrum or a torn liga-
mentum teres can also lead to an in-
complete reduction.
3,17
Any joint widening noted on ra-
diographs should be evaluated with
computerized tomography (CT) or
magnetic resonance imaging (MRI).
CT has been shown to be effective
in detecting osteochondral lesions,
whereas MRI is more effective in de-
termining soft-tissue interposition,
which may limit concentric reduc-
tion of the femoral head. Approxi-
mately 25%of the patients in a large
series of pediatric hip dislocations
had an interposed labrum or a loose
osteochondral fragment requiring
surgical intervention.
3
Removal of
any interposed tissue is required to
achieve anatomic reduction, even
when the diagnosis is delayed by
several months.
16,18
Removal of in-
terposed materials should be per-
formed from the direction of the dis-
location (Figure 1).
Spontaneous Incongruous
Reduction
Eveninadolescents, minor trauma
can produce a transient hip disloca-
tion that spontaneously reduces but
does so with capsular interposition
and joint incongruity
16,19
(Figure 2, A).
The absence of radiographic verifica-
tion of dislocation after a hip injury
in an adolescent may lead to a delay
in diagnosis of spontaneous, unrecog-
nized, incongruous reduction. Any
adolescent who presents with hip,
thigh, or knee pain after a traumatic
event should be carefully examined
and evaluated with appropriate imag-
ing studies. Any joint widening seen
onradiographs should be further eval-
uated with CTor MRI scans, even in
the absence of a past or existing hip
dislocation
3
(Figure 2, B).
Figure 1
Intraoperative photograph of a
procedure done to repair an intra-
articular osteocartilaginous fragment
and capsule after open arthrotomy.
Traumatic Hip Dislocations in Children and Adolescents: Pitfalls and Complications
16 Journal of the American Academy of Orthopaedic Surgeons
Femoral Head
Epiphysiolysis
Fracture-separation of the proxi-
mal femoral epiphysis is a recog-
nized pattern for a hip fracture asso-
ciated with traumatic hip dislocation
in the adolescent patient.
9,11,20
This
type of injury has a dismal prognosis,
with nearly all involved hips (ie,
femoral heads) developing osteone-
crosis. A subgroup of adolescent pa-
tients with hip dislocation presents
with a fracture-separation of the
proximal femoral epiphysis (ie, phys-
eal instability) without displacement
of the femoral head, as a result of the
trauma of dislocation. Radiographs
of these patients will seem to dem-
onstrate a simple dislocation.
Although urgent reduction of dis-
located hips is recommended to re-
duce the risk of osteonecrosis, this
approach may be complicated by the
presence of an unrecognized physeal
injury. Physeal instability may place
the femoral head at risk for displace-
ment during the reduction maneu-
ver. This result has been reported in
the reduction of hip dislocation
specifically in adolescents aged 12 to
16 years, but not in younger pa-
tients.
10,11
In other words, a femoral
head fracture or separation with dis-
placement of the proximal femoral
epiphysis may occur during attempt-
ed reduction of the femoral head into
the acetabulum (Figure 3, A and B).
In these cases, osteonecrosis is a cer-
tain outcome
10,11
(Figure 3, C).
Epiphysiolysis (ie, femoral head
displacement) has also been reported
even when reduction has been per-
formed with complete relaxation
under general anesthesia. Therefore,
in the adolescent patient, consider-
ation should be given to complete
muscle relaxation and continuous
imaging during the closed reduction
maneuver to detect physeal instabil-
ity during manipulation. When in-
stability is noted, the fracture should
be surgically stabilized before hip re-
duction.
10
When femoral head epiphysioly-
sis is diagnosed, whether traumatic
or postreduction, the surgical ap-
proach should be from the direction
of the dislocation, which is usually
posterior. Pinning of the physeal
Figure 2
A, Anteroposterior radiograph of the pelvis of a 10-year-old girl following a fall. She
had immediate and persistent left hip pain. The patient was sent home on pain
medication for what was misdiagnosed as a groin pull. B, Axial computed
tomography scan made in a second evaluation, after the patient reported persistent
pain, with the suspicion of intra-articular pathology, demonstrating evidence of an
intra-articular osteocartilaginous fragment (circled).
Figure 3
A, Anteroposterior view of a right hip demonstrating a simple hip dislocation. B, Postreduction anteroposterior radiograph
demonstrating displacement of the femoral head (ie, epiphysiolysis). This image was taken after the patient underwent gentle
manipulation under conscious sedation in the emergency department. C, Anteroposterior radiograph taken 15 months after the
injury and open reduction, demonstrating osteonecrosis of the femoral head.
Jos A. Herrera-Soto, MD, and Charles T. Price, MD
Volume 17, Number 1, January 2009 17
fracture-separation following growth
plate excision facilitates reduction of
the femoral head into the acetabu-
lum. During surgery, great care
should be taken to protect the pos-
terolateral epiphyseal vessels and
periosteum attached to the femoral
head.
21
Femoral head fractures have
also been reported in hip dislocation
in children and have poor outcomes,
regardless of management meth-
od.
22
Missed Associated Injuries
The diagnosis of traumatic hip
dislocation should alert the treating
physician to the possibility of associ-
ated injuries, especially in the ado-
lescent patient with high-energy
trauma. Acetabular fractures in-
crease the risk of long-term osteoar-
thritis of the hip.
15
Femoral head and
greater trochanteric fractures, al-
though rare, may also occur in the
adolescent patient. It has been
shown that obvious abnormalities
capture visual attention, but they
can also lead to the abandonment of
vigilance for more subtle abnormal-
ities.
23,24
The rate of detection of ad-
ditional fractures is inversely related
to the severity of the originally de-
tected fracture (Figure 4). This type
of error has been labeled satisfac-
tion of search.
23,24
The literature in-
dicates that details of fracture de-
scription decrease when more than
one fracture is present.
23
Thus, the
presence of a hip dislocation can eas-
ily lead to misdiagnosis of associat-
ed injuries and failure to recognize
additional fractures, or a fracture di-
agnosis may lead to failure to diag-
nose a hip dislocation.
Hip joint asymmetry may be
overlooked in patients with multiple
trauma. Banskota et al
25
presented a
series of eight patients with neglect-
ed traumatic hip dislocations. All of
these patients developed osteonecro-
sis. Concentric reduction is essential
to achieve a good functional out-
come without osteonecrosis.
25
Unrecognized Dislocation
Hip dislocation may go unrecog-
nized, especially in multitrauma pa-
tients or in instances in which trau-
ma seems insufficient to produce
such dislocation. The index of suspi-
cion should be raised in the presence
of persistent hip pain, limp, limb-
length inequality, or decreased range
of motion after minor trauma.
25,26
Any abnormal extremity position
should raise the suspicion of a hip
dislocation.
It has been suggested that open
reduction, even if delayed, is a satis-
factory treatment for neglected hip
dislocation in children because an
anatomically positioned femoral
head will maintain the stimulus for
growth of the pelvis and the femur.
This approach, now recommended,
may prevent deformity and will
maintain limb length.
26
Skeletal
traction did not help to achieve re-
duction in two series reporting de-
lays in diagnosis of hip disloca-
tion.
25,26
Complications
Osteonecrosis
The most frequent serious compli-
cationafter hip dislocationis osteone-
crosis of the femoral head. In children
younger than age 18 years, the inci-
dence of osteonecrosis after an iso-
lated hip dislocation is 3% to
15%.
2,3,9,18
When a traumatic hip dis-
location is associated with femoral
epiphysiolysis, the risk increases to
almost 100%.
9-11,20
Various reports
confirm that early reduction of the
dislocation is one of the most impor-
tant factors in preventing osteonecro-
sis of the femoral head.
2,3,22
Despite
the urgency to perform a concentric
hip reduction, this must be ap-
proached withcautioninadolescents.
Mehlman et al
2
reported that the
goldenperiod of reductionto decrease
the likelihood of osteonecrosis in
children was within 6 hours of the in-
jury. When reduction is performed
more than 6 hours after injury, the
risk of osteonecrosis increased 20-
fold.
2
A patient who has delayed re-
duction should undergo MRI or bone
scintigraphy 3 to 6 months postinjury
to detect early osteonecrosis. How-
ever, a bone scan does not seemto be
consistent in detecting osteonecrosis
because some studies report early ab-
normal findings without deleterious
consequences.
2,3
Treatment of osteonecrosis de-
pends on the age of the patient. Chil-
dren younger than age 12 years who
develop osteonecrosis will develop
femoral head changes similar to
those seen with Legg-Calv-Perthes
disease. These patients are managed
similarly to those with Legg-Calv-
Perthes disease and have a better
prognosis than do older children,
whose osteonecrotic changes are
similar to those found in adults.
27
However, most authorities agree that
the outcome of osteonecrosis of the
Figure 4
Anteroposterior radiograph of the left
femur of a 13-year-old boy who
sustained multiple injuries in a motor
vehicle accident. The injuries included
a left traumatic hip dislocation with
associated femoral head displacement
as well as open left femur and tibia
fractures. Treatment consisted of
dbridement and external fixation of
the femoral shaft, followed by open
reduction and internal fixation of the
femoral head and capsular repair.
Traumatic Hip Dislocations in Children and Adolescents: Pitfalls and Complications
18 Journal of the American Academy of Orthopaedic Surgeons
femoral head following a traumatic
injury is likely to be poor.
10,20,28
Management of osteonecrosis in
adolescents is controversial and dif-
ficult, and it relies on reported expe-
rience acquired in the management
of adult patients. Treatment methods
and techniques applied before femo-
ral head collapse include contain-
ment, core decompression, distrac-
tion arthroplasty, and vascular fibula
graft. Core decompression may be
considered before femoral head col-
lapse in older patients.
29-33
Growth ar-
rest of the proximal physis in the ad-
olescent is a lesser concern than
preservationof articular congruity be-
cause the proximal femoral growth
plate contributes little to overall limb
growth after age 12 years.
Osteonecrosis that develops with
segmental collapse of the femoral
head is difficult to manage in adoles-
cents. Vascularized fibular grafts are
a treatment option before segmental
collapse of the femoral head occurs.
34
After femoral head collapse, femoral
and pelvic osteotomies and bone
grafting procedures have been at-
tempted, with limited success, de-
pending on the size and location of
the infarct.
35,36
The currently accepted
treatment of osteonecrosis with col-
lapse of the femoral head in adults is
replacement arthroplasty. However,
replacement arthroplasty for the pe-
diatric patient is controversial be-
cause of the potentially limited life
spanof the prosthesis.
35,37,38
Currently,
arthrodesis of the hip may be the
most reasonable option for severe os-
teonecrosis of the hip in the adoles-
cent patient.
39-42
Newer methods of
resurfacing arthroplasty have demon-
strated promising early results, but
these are still controversial for the ad-
olescent age group.
29,43,44
Irreducible Dislocation
An irreducible or unstable dislo-
cation is an indication for surgical
management and should be per-
formed emergently to decrease the
risk of osteonecrosis. Irreducible dis-
locations should be approached from
the direction of the dislocation. Any
torn capsular material should be re-
paired to add stability to the reduc-
tion. Labral tears should be repaired,
dbrided, or resected according to
size and the pattern of the tear.
Recurrent Dislocation
Recurrent hip dislocation has
been reported in children (generally,
age 8 years and younger) and is at-
tributed to the soft, pliable nature
of the posterior acetabular carti-
lage.
18,45,46
Whether to immobilize a
young child is controversial.
14
Sever-
al pediatric orthopaedic surgeons
recommend bed rest for children.
However, there have been no report-
ed differences between those treated
with prolonged rest and those treat-
ed with a brief period of rest. Spica
casting without surgical interven-
tion has also been recommended for
children with a recurrent disloca-
tion.
45
Time of immobilization be-
fore progression to full weight bear-
ing has not been shown to alter the
incidence of redislocations.
12,47,48
Some surgeons advocate performing
hip arthrography to assess capsular
integrity when recurrent dislocation
is a problem.
49-52
Fortunately, chron-
ic instability is an infrequent prob-
lem; it can be corrected by open cap-
sular repair and is advocated in
patients who demonstrate a tear and
persistent instability.
49,51,53
Osteoarthritis
Traumatic arthritis is the most
common complication in the adult
population following hip dislocation.
In the absence of osteonecrosis, it has
rarely been reported for children with
hip dislocation.
7
Osteoarthritis as a
result of osteonecrosis has been re-
ported in up to 20% of patients at
time of follow-up.
15
Figure 5 demon-
strates an incongruous reduction that
was not addressed. The patient devel-
Figure 5
A, Anteroposterior pelvis radiograph of an 11-year-old boy with right hip dislocation. B, Axial computed tomography scan
demonstrating an intra-articular fragment (circled) that was not removed after reduction because of its small size. C, Several
years later, the patient presented with persistent hip pain. The anteroposterior hip radiograph demonstrates changes consistent
with osteonecrosis and osteoarthrosis of the right hip.
Jos A. Herrera-Soto, MD, and Charles T. Price, MD
Volume 17, Number 1, January 2009 19
oped early osteoarthritis several years
after injury.
Neurologic Injury
The sciatic and superior gluteal
nerves may be injured at the time of
dislocation.
54
Approximately 5% of
children with hip dislocation will
have neurologic findings. The pero-
neal branch of the sciatic nerve is
the most likely peripheral nerve to
be injured. Prompt reduction of the
hip is recommended, followed by ob-
servation of the nerve recovery. Ex-
ploration is not warranted unless
open reduction is required for other
reasons. Return of sciatic nerve
function can be expected for most
patients.
Other Complications
Other reported late complications
include coxa magna and heterotopic
bone formation. Coxa magna, al-
though present in up to 26% of pa-
tients, is rarely symptomatic.
18
This
finding is more common in the
younger patient (<10 years) and does
not appear to be proportional to the
trauma sustained.
3
Heterotopic bone
formation is a rare complication in
children. Resection of heterotopic
bone should be performed in a child
only when it is symptomatic and af-
ter the bone has matured. Premature
closure of the triradiate cartilage has
also been described in children, but
this is exceedingly rare in the absence
of central fracture of the acetabu-
lum.
15,51,55
Summary
Traumatic hip dislocation in the pe-
diatric population is an uncommon
but significant condition. Early rec-
ognition of the dislocation, timely
application of closed reduction, and
mindfulness and avoidance of pit-
falls and potential long-termcompli-
cations are important to a successful
outcome. Early diagnosis and treat-
ment will also reduce the risk of
osteonecrosis. Radiographic assess-
ment by anteroposterior, oblique,
and lateral imaging of the pelvis is
crucial before and after reduction.
When any uncertainties exist regard-
ing hip joint congruency, a CT or
MRI scan should be performed to
identify intra-articular bone frag-
ments or interposed soft tissue. An
adolescent with a history of hip trau-
ma and persistent pain should be
carefully assessed for hip joint asym-
metry, even in the absence of docu-
mented hip dislocation. Particular
caution during reduction of hip dis-
location is warranted in the adoles-
cent because of the risk of femoral
head physeal displacement during
manipulation. When open reduction
is required, the surgical approach
should be from the direction of the
dislocation. Complications may oc-
cur following hip dislocation and
medical treatment in children, but
the results of early treatment are
generally satisfactory.
References
Evidence-based Medicine: There are
no level I or level II studies cited.
Most of the references are level III
case-control studies (1, 2, 5, 7, 8, 10,
12, 15, 22-25, 28, 31, 33, 38, 40, 42,
and 44) or level IV case series (3, 4, 9,
11, 13, 14, 16-19, 21, 26, 30, 32, 36,
37, 39, 41, 45, 46, 48-52, and 55). The
remaining references are level V ex-
pert opinion.
Citation numbers printed in bold
type indicate references published
within the past 5 years.
1. Barquet A: Avascular necrosis follow-
ing traumatic hip dislocationinchild-
hood: Factors of influence. Acta Or-
thop Scand 1982;53:809-813.
2. Mehlman CT, Hubbard GW, Craw-
ford AH, Roy DR, Wall EJ: Traumatic
hip dislocation in children: Long-
term followup of 42 patients. Clin
Orthop Relat Res 2000;376:68-79.
3. Vialle R, Odent T, Pannier S, Pauthier
F, Laumonier F, Glorion C: Trau-
matic hip dislocation in childhood.
J Pediatr Orthop 2005;25:138-144.
4. Vontobel BJ, Hocevar Z, Jakob RP:
Avascular necrosis following trau-
matic hip dislocation in an 8-year-old
boy. Arch Orthop Trauma Surg 1994;
113:83-85.
5. Yang RS, Tsuang YH, Hang YS, Liu TK:
Traumatic dislocation of the hip.
Clin Orthop Relat Res 1991;265:218-
227.
6. Trousdale RT: Comment: Traumatic
hip dislocation during childhood.
Am J Orthop 1997;26:73, 76.
7. Hougaard K, Thomsen PB: Traumatic
hip dislocation in children: Follow up
of 13 cases. Orthopedics 1989;12:
375-378.
8. Kutty S, Thornes B, Curtin WA,
Gilmore MF: Traumatic posterior dis-
location of hip in children. Pediatr
Emerg Care 2001;17:32-35.
9. Barquet A, Vcsei V: Traumatic dislo-
cation of the hip with separation of
the proximal femoral epiphysis: Re-
port of two cases and reviewof the lit-
erature. Arch Orthop Trauma Surg
1984;103:219-223.
10. Herrera-Soto JA, Price CT, Reuss BL,
Riley P, Kasser JR, Beaty JH: Proximal
femoral epiphysiolysis during reduc-
tion of hip dislocation in adolescents.
J Pediatr Orthop 2006;26:371-374.
11. Odent T, Glorion C, Pannier S, Bron-
fen C, Langlais J, Pouliquen JC: Trau-
matic dislocation of the hip with sep-
aration of the capital epiphysis: 5
adolescent patients with 3-9 years of
follow-up. Acta Orthop Scand 2003;
74:49-52.
12. Epstein HC: Traumatic dislocations
of the hip. Clin Orthop Relat Res
1973;92:116-142.
13. Salisbury RD, Eastwood DM: Trau-
matic dislocation of the hip in chil-
dren. Clin Orthop Relat Res 2000;
377:106-111.
14. Gianom D, Kronberger G, Sacher P:
Long-termfollow-up of traumatic hip
fracture in childhood [German]. Helv
Chir Acta 1994;60:623-627.
15. Guingand O, Rigault P, Padovani JP,
Finidori G, Touzet P, Depotter J: Trau-
matic hip dislocations and acetabular
fractures in children [French]. Rev
Chir Orthop Reparatrice Appar Mot
1985;71:575-585.
16. Price CT, Pyevich MT, Knapp DR,
Phillips JH, Hawker JJ: Traumatic hip
dislocation with spontaneous incom-
plete reduction: A diagnostic trap.
J Orthop Trauma 2002;16:730-735.
17. Vialle R, Pannier S, Odent T, Schmit
P, Pauthier F, Glorion C: Imaging of
traumatic dislocation of the hip in
childhood. Pediatr Radiol 2004;34:
970-979.
18. Offierski CM: Traumatic dislocation
of the hip in children. J Bone Joint
Surg Br 1981;63:194-197.
Traumatic Hip Dislocations in Children and Adolescents: Pitfalls and Complications
20 Journal of the American Academy of Orthopaedic Surgeons
19. Olsson O, Landin LA, Johansson A:
Traumatic hip dislocation with spon-
taneous reduction and capsular inter-
position: A report of 2 children. Acta
Orthop Scand 1994;65:476-479.
20. Ratliff AH: Traumatic separation of
the upper femoral epiphysis in young
children. J Bone Joint Surg Br 1968;
50:757-770.
21. Mass DP, Spiegel PG, Laros GS: Dislo-
cation of the hip with traumatic sep-
aration of the capital femoral epiphy-
sis: Report of a case with successful
outcome. Clin Orthop Relat Res
1980;146:184-187.
22. EpsteinHC, Wiss DA, CozenL: Poste-
rior fracture dislocation of the hip
with fractures of the femoral head.
Clin Orthop Relat Res 1985;201:9-
17.
23. Ashman CJ, Yu JS, Wolfman D: Satis-
faction of search in osteoradiology.
AJR Am J Roentgenol 2000;175:541-
544.
24. Berbaum KS: Comment: Satisfaction
of search in osteoradiology. AJR Am J
Roentgenol 2001;177:252-253.
25. Banskota AK, Spiegel DA, Shrestha S,
Shrestha OP, Rajbhandary T: Openre-
duction for neglected traumatic hip
dislocation in children and adoles-
cents. J Pediatr Orthop 2007;27:187-
191.
26. Kumar S, JainAK: Neglected traumat-
ic hip dislocation in children. Clin
Orthop Relat Res 2005;431:9-13.
27. Barquet A: Natural history of avascu-
lar necrosis following traumatic hip
dislocation in childhood: A review of
145 cases. Acta Orthop Scand 1982;
53:815-820.
28. Canale ST, Bourland WL: Fracture of
the neck and intertrochanteric region
of the femur in children. J Bone Joint
Surg Am 1977;59:431-443.
29. Mont MA, Ragland PS, Parvizi J: Sur-
gical treatment of osteonecrosis of the
hip. Instr Course Lect 2006;55:167-
172.
30. Lieberman JR, Conduah A, Urist MR:
Treatment of osteonecrosis of the
femoral head with core decompres-
sion and human bone morphogenetic
protein. Clin Orthop Relat Res 2004;
429:139-145.
31. Mont MA, Einhorn TA, Sponseller
PD, Hungerford DS: The trapdoor pro-
cedure using autogenous cortical and
cancellous bone grafts for osteonecro-
sis of the femoral head. J Bone Joint
Surg Br 1998;80:56-62.
32. Mont MA, Ragland PS, Etienne G:
Core decompression of the femoral
head for osteonecrosis using percuta-
neous multiple small-diameter drill-
ing. Clin Orthop Relat Res 2004;429:
131-138.
33. Steinberg ME, LarcomPG, StraffordB,
et al: Core decompression with bone
grafting for osteonecrosis of the femo-
ral head. Clin Orthop Relat Res
2001;386:71-78.
34. Urbaniak JR, Harvey EJ: Revascular-
izationof the femoral headinosteone-
crosis. J Am Acad Orthop Surg 1998;
6:44-54.
35. Wedge JH: Hip pain in adolescence.
Clin Orthop Relat Res 1987;225:93-
103.
36. Ntzli HP, Chou LB, Ganz R: Open-
reduction and intertrochanteric os-
teotomy for osteonecrosis and ex-
trusion of the femoral head in
adolescents. J Pediatr Orthop 1995;
15:16-20.
37. Gent E, Clarke NM: Joint replace-
ment for sequelae of childhood hip
disorders. J Pediatr Orthop 2004;24:
235-240.
38. Rubinstein RA Jr, Beals RK: The re-
sults of treatment of posttraumatic
avascular necrosis of the femoral head
in young adults: Report of 31 patients.
Contemp Orthop 1993;27:527-532.
39. Roberts CS, Fetto JF: Functional out-
come of hip fusion in the young pa-
tient: Follow-up study of 10 patients.
J Arthroplasty 1990;5:89-96.
40. Tavares JO, Frankovitch KF: Hip ar-
throdesis using the AO modular ex-
ternal fixator. J Pediatr Orthop 1998;
18:651-656.
41. Schoenecker PL, Johnson LO, Martin
RA, Doyle P, Capelli AM: Intra-
articular hip arthrodesis without sub-
trochanteric osteotomy in adolescents:
Technique and short-term follow-up.
Am J Orthop 1997;26:257-264.
42. Mowery CA, Houkom JA, Roach JW,
Sutherland DH: A simple method of
hip arthrodesis. J Pediatr Orthop
1986;6:7-10.
43. Grecula MJ: Resurfacing arthroplasty
in osteonecrosis of the hip. Orthop
Clin North Am 2005;36:231-242.
44. Adili A, Trousdale RT: Femoral head
resurfacing for the treatment of os-
teonecrosis in the young patient.
Clin Orthop Relat Res 2003;417:93-
101.
45. Muratli HH, Dag li C, Biimog lu A,
Tabak AY: Recurrent traumatic hip
dislocation in a child [Turkish]. Acta
Orthop Traumatol Turc 2004;38:149-
153.
46. Barquet A: Recurrent traumatic dislo-
cation of the hip in childhood.
J Trauma 1980;20:1003-1006.
47. Scientific Research Committee of the
Pennsylvania Orthopaedic Society:
Traumatic dislocation of the hip joint
in children. Final report. J Bone Joint
Surg Am 1968;50:79-88.
48. Schlonsky J, Miller PR: Traumatic hip
dislocations in children. J Bone Joint
Surg Am 1973;55:1057-1063.
49. Slavk M, Dungl P, Sprindrich J,
Ste dr V: Recurrent traumatic dislo-
cation of the hip in a child: Signifi-
cance of early hip arthrography. Arch
Orthop Trauma Surg 1986;104:385-
388.
50. Klein A, Sumner TE, Volberg FM, Or-
bon RJ: Combined CT-arthrography
in recurrent traumatic hip disloca-
tion. AJR Am J Roentgenol 1982;138:
963-964.
51. Wilchinsky ME, Pappas AM: Unusual
complications in traumatic disloca-
tion of the hip in children. J Pediatr
Orthop 1985;5:534-539.
52. Glynn TP Jr, Kreipke DL, DeRosa GP:
Computed tomography arthrography
in traumatic hip dislocation: Intra-
articular and capsular findings.
Skeletal Radiol 1989;18:29-31.
53. Ahmadi B, Harkess JW: Habitual dis-
location of the hip: A new, simple
classification and report of a case.
Clin Orthop Relat Res 1983;175:209-
212.
54. Cornwall R, Radomisli TE: Nerve in-
jury in traumatic dislocation of the
hip. Clin Orthop Relat Res 2000;377:
84-91.
55. Scuderi G, BronsonMJ: Triradiate car-
tilage injury: Report of two cases and
review of the literature. Clin Orthop
Relat Res 1987;217:179-189.
Jos A. Herrera-Soto, MD, and Charles T. Price, MD
Volume 17, Number 1, January 2009 21