title: Emergency department diagnosis and treatment of traumatic hip dislocations in children under the age of 7 years: a 10-year review.
abstract: OBJECTIVE
  Traumatic hip dislocations (THD) are uncommon in children. They constitute true emergencies because unrecognised THD leads to avascular necrosis (AVN) of the femoral head. This review presents the evidence for best practice for the diagnosis and treatment of THD in the emergency department (ED) of children under the age of 7 years.
  
  
  METHODS
  Searches for the period 2002-2012 were performed in PubMED, Cochrane database, EMBASE, Google Scholar and hand search.
  
  
  RESULTS
  Twenty-five case reports and case series articles were identified, 53 described children with acute and 23 with neglected THD. Overall, 42 (55%) were male and 73 (96%) sustained a posterior dislocation. Forty-eight (63%) had THD following a low-energy trauma. Eight (11%) reported associated injuries. Twenty-one (39.6%) acute dislocations were reduced in the ED without complications. AVN was identified in 3 (5.7%) children, who underwent reduction ≥10 h after dislocation. Redislocation occurred in 3 (5.7%) children and coxa magna developed in 5 (9.4%). Long-term functional outcome of 42 patients resulted in full recovery, and it was fair to good in 3 (including 2 children with AVN). All neglected cases (≥4 weeks from trauma) needed open reduction in the operating room (OR). AVN was identified in 11 children (47.8%). Hip function was completely recovered in 16 (70%) patients.
  
  
  CONCLUSIONS
  THD in this age group mainly occurs with low-energy trauma and leads to posterior dislocations. Urgent closed reduction of acute cases are done in the OR, or the ED. ED reduction appears to be safe. Neglected THDs need open reduction.
authors.affiliation: Department of Women's and Children's Health, Division of Pediatric Emergency Medicine, University of Padova, Padova, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bressan
authors.affiliation: Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Ivan Peter
authors.initials: IP
authors.lastname: Steiner
authors.affiliation: Pediatric Emergency Department, Rappaport Faculty of Medicine, Rambam Health Care Campus, Technion University, Haifa, Israel.
authors.forename: Itai
authors.initials: I
authors.lastname: Shavit
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006617:Hip Dislocation / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male
keywords: Fractures and Dislocations; Paediatrics, Paediatric Emergency Medicine; Paediatrics, Paediatric Injury; Trauma, Extremity