Pediatric Hip Dislocations

Pediatric hip dislocations are a rare event that carry significant risks for long term disability if managed inappropriately. Often a low energy mechanism is seen in children younger than 10, while a higher energy mechanism is typically seen in adolescents as bone and soft tissue structures become more rigid. Ideally, Closed reduction should take place within six hours to limit the risk of osteonecrosis1. Post reduction x-rays should be carefully scrutinized to evaluate joint space asymmetry. Any asymmetry should be evaluated with CT and MRI to evaluate for labral, capsule, or ligamentum teres interposition in addition to osteochondral fragments. About 25% of pediatric hip dislocations will have interposed labrum or osteochondral fragments
preventing a concentric reduction2. Traditionally, in cases where a concentric closed reduction wasn’t possible, open reduction with an arthrotomy and possible surgical dislocation is indicated with direct visualization of the joint, removal of incarcerated fragments, and soft tissue repair or debridement. However, the increased prevalence of adult hip arthroscopy and a focus on hip preservation has lead to the expansion of indications into the pediatric population. Challenges of hip arthroscopy in this population include smaller habitus and presence of tri-radiate, femoral, and acetabular physeal cartilage. One of the earliest techniques described by Goss in 1977 used an anterior and subadductor portal to treat developmental dysplasia of the hip (DDH), Legg Calve Perthes, and other disorders (ROY). Current indications include intra-articular evaluation of infantile DDH with arthroscopically assisted reduction, treatment of loose bodies, labral pathology, and chrondal tears associated with LCP, osteoplasty in femoral acetabular impingement, and irrigation and debridement of a septic joint (ROY). The use of hip arthroscopy in a traumatic hip dislocation is another emerging indication.