Traumatic posterior dislocation of the paediatric hip--a series of five cases.
Traumatic dislocation of the hip in paediatric age group is a rare injury.  It has bimodal distribution.  Incidence is greater between 2 and 5 years of age due to joint laxity and soft cartilage and between 11 and 15 years of age because of athletic injuries and road traffic accidents.  Posterior dislocations occur due to axial load on flexed and adducted hip, while anterior dislocations occur with a combination of abduction and external rotation.  The ideal management is a prompt diagnosis and reduction following which outcome is usually satisfactory. Here, we are reporting five cases of traumatic posterior hip dislocation in skeletally immature patients.
MATERIALS AND METHODS
Five cases of traumatic dislocation of the hip in children treated between 2009 and 2015 have been included in this study. Details of the patients are listed in Table 1.
The limb was kept in skin traction on Thomas splint following reduction, which was continued for 3 weeks. Hip Spica was applied in case of associated shaft femur fracture 3 weeks post traction for another 3 weeks. All patients showed good range of motion at 6 weeks post reduction.
Two cases have been illustrated below by clinical photographs.
A review of the literature shows that traumatic dislocation of the hip in children is a rare injury ,, and bilateral dislocation is almost an exception. , It is seen that posterior dislocation is a commoner than anterior dislocation as in adults. , In our study all the cases were of posterior dislocation and all the patients were boys indicating a predominance of male individuals as reported in the literature. ,
The hip is in flexion, adduction and internal rotation in posterior hip dislocation.  The involved limb appears shorter than the contralateral limb and the femoral head can be palpated posteriorly in posterior type of hip dislocation. 
Even though the diagnosis is usually obvious, it is delayed or missed sometimes. , The common cause for a delayed diagnosis is presence of another fracture or injury that diverts attention from the dislocated hip. , Sciatic nerve injury may occur in 5% to 20% of cases. ,,
The treatment is immediate closed reduction under general anaesthesia. Rarely, open reduction may be required in failed cases of closed reduction either due to buttonholing of the femoral head through the hip capsule or due to infolding of the acetabular labrum. ,, Open reduction was not required in our series.
Good quality radiographs should be done post reduction to confirm a congruent reduction and to rule out any fracture. If in doubt, computed tomography should be done.
Majority of the authors recommend 6 weeks of immobilisation in traction or hip spica followed by weight bearing.
Associated injuries of the ipsilateral/contralateral limb may lead to missing the diagnosis causing delay in management, so the patient should be examined thoroughly and should be re-examined if required.
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Bhupes Sil (1), Ajay Kr. Goel (2), Sankar Debroy (3)
(1) Assistant Professor, Department of Orthopaedics, AGMC and GBPH, Agartala, Tripura.
(2) Junior Resident, Department of Orthopaedics, AGMC and GBPH, Agartala, Tripura.
(3) Assistant Professor, Department of Orthopaedics, AGMC and GBPH, Agartala, Tripura.
Financial or Other, Competing Interest: None.
Submission 11-06-2016, Peer Review 25-01-2017, Acceptance 31-01-2017, Published 09-02-2017.
Corresponding Author: Dr. Bhupes Sil, Type 4, A/1 Govt. Quarters, Gandhighat, Agartala, Tripura (W)-799001.
Caption: Figure 1. Flexion, Adduction and Internal Rotation
Caption: Figure 2. Apparent Shortening
Caption: Figure 3. Post Reduction
Caption: Figure 4. Surface Traction Immobilisation
Caption: Figure 5. Pre-Reduction X-Ray
Caption: Figure 6. Post-Reduction X-Ray
Caption: Fig 1: # Shaft Femur in Thomas Splint (Rt.) and Missed Posterior Dislocation Hip (Lt.)
Caption: Fig 2: X-ray Showing # shaft Femur (Rt) and Missed Dislocation(Lt.) (not clear)
Caption: Figure 3. Repeat Radiograph shows Dislocation Hip Joint (Lt.)
Caption: Figure 4. Post Reduction X-Ray
Table 1. Details of the Patients Patient No. Age Sex Type of Mode of Injury Dislocation 1. 2 years M Posterior Fall 6 from Months bed 2. 3 M Posterior Road years dislocation traffic (left) accident associated with fracture shaft femur (right) 3. 6 M Posterior Fall years while playing 4. 9 M Posterior Road years traffic accident 5. 10 M Posterior Road years traffic accident Patient No. Sidedness Time Interval between Injury and Reduction 1. Right 5 hours 2. Dislocation 15 hours (Left) Fracture (Right) 3. Left 6 hours 4. Left 5 hours 5. Right 4 hours 30 mins.
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|Title Annotation:||Case Series|
|Author:||Sil, Bhupes; Goel, Ajay Kr.; Debroy, Sankar|
|Publication:||Journal of Evolution of Medical and Dental Sciences|
|Article Type:||Clinical report|
|Date:||Feb 9, 2017|
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