Traumatic Anterior Dislocation of the Hip Associated with Ipsilateral Femoral Shaft Fracture in a Child: A Case Report

Abstract

Traumatic anterior dislocation of the hip joint in children is rare, and only one case with ipsilateral femoral fracture has been reported in Japan. We report a case of such dislocation and a review of the literature. The patient was a 31-month-old girl who was injured in a car accident while asleep on a tilted front passenger seat. Radiographic examination showed dislocation of the right obturator foramen and transverse fracture of the ipsilateral femoral shaft. The dislocation of the right hip was easily reduced without anaesthesia during radiography. We applied Bryant traction after reduction for 4 weeks, followed by cast application for 3 weeks. Walking with support and full weightbearing were permitted 14 weeks and 16 weeks after the injury, respectively. Radiography at 4.5 years after the injury showed a mildly enlarged right femoral head and femur overgrowth of approximately 8 mm. Magnetic resonance imaging showed no evidence of suspected avascular necrosis of the femoral head. The patient has no subjective or objective symptoms, and is able to engage in all usual activities. The detailed mechanism of the injury is unknown. We assume that the lower leg was dislocated through abduction during flexion, or abducent, external flexion, considering that the child was sleeping at the time of the accident. Since she was hurled to the back seat, it was assumed that strong external force was vertically added to the femur, which caused the abducent force.

Keywords

child,preschool femoral fracture femur head necrosis hip dislocation

References

Malkawi

. Traumatic anterior dislocation of the hip with fracture of the shaft of the ipsilateral femur in children: Case report and review of the literature. J Pediatr Orthop 1982;2:307–11.

Brav

. Traumatic dislocation of the hip: Army experience and results over a twelve-year period. J Bone Joint Surg Am 1962;44:1115–34.

Stewart

Milford

. Fracture-dislocation of the hip; an end-result study. J Bone Joint Surg Am 1954;36:315–42.

Matsubara

. Traumatic dislocation of the hip joint—analysis of the therapeutic methods from the standpoint of clinical features and results of the treatment [in Japanese]. Nippon Seikeigeka Gakkai Zasshi 1970;44:995–1013.

Proctor

. Dislocation of the hip joint (excluding ‘central’ dislocations) and their complications. Injury 1973;5:1–12.

Barquet

. Traumatic hip dislocation in childhood. A report of 26 cases and review of the literature. Acta Orthop Scand 1979;50:549–53.

Barquet

. Traumatic hip dislocation with fracture of the ipsilateral femoral shaft in childhood. Report of a case and review of the literature. Arch Orthop Trauma Surg 1981;98:69–72.

Fardon

. Femoral shaft fracture with ipsilateral hip dislocation in a child. JACEP. 1978;7:159–61.

Glass

Powell

. Traumatic dislocation of the hip in children an analysis of forty-seven patients. J Bone Joint Surg Br 1961;43:29–37.

10.

Pearson

Mann

. Traumatic hip dislocation in children. Clin Orthop 1973;92:189–94.

11.

Funk

. Traumatic dislocation of the hip in children. J Bone Joint Surg Am 1962;44:1135–45.

12.

Epstein

. Traumatic dislocation of the hip. Clin Orthop 1973;92:116–42.

13.

Tokinaga

. Two cases of closure dislocation of hip [in Japanese]. Tokyo Iji Shinshi 1917;2014:507–11.

14.

Ueke

Takai

Onitake

Horie

Usami

. Two cases of traumatic anterior dislocation of hip in children [in Japanese]. Chubu Seisaishi 1979;22:947–50.

15.

Sako

Ishii

Kawaji

. A case of traumatic dislocation of hip in children complicated with ipsilateral fracture of shaft of femur [in Japanese]. Kanto Seisaishi 1985;16:383–6.

16.

Sone

Okuno

Harada

Nishida

. A case of traumatic anterior dislocation of hip in children [in Japanese]. Tohoku Seisai Kiyo 1984;22:60–2.

17.

Kihara

Beppu

Shimizu

. Three cases of traumatic dislocation of hip in children [in Japanese]. J Jpn Ped Orthop Ass 1997;6:192–6.

18.

Ryo

Matsuzaki

Sugiura

Satoh

Oikawa

Kishimoto

. Two cases of traumatic dislocation of hip in children [in Japanese]. Saitama-ken Igakukai Zasshi 1998;32:816–20.

19.

Slater

Allen

. Traumatic hip dislocation with ipsilateral femoral shaft fracture in a child: An ‘open and closed’ case. Injury 1992;23:60–1.

20.

Ehtisham

. Traumatic dislocation of hip joint with fracture of shaft of femur on the same side. J Trauma 1976;16:196–205.

21.

Kammer

. On the complication of dislocation with fracture of the femur, with a case. New York J Med 1889;49:175–80.

22.

Helal

Skevis

. Unrecognised dislocation of the hip in fractures of the femoral shaft. J Bone Joint Surg Br 1967;49:293–300.

23.

Poggi

Callaghan

Spritzer

Roark

Goldner

. Changes on magnetic resonance images after traumatic hip dislocation. Clin Orthop 1995;319;249–59.