title: Surgical Hip Dislocation is Safe and Effective Following Acute Traumatic Hip Instability in the Adolescent.
abstract: BACKGROUND
  A traumatic hip dislocation in the pediatric patient is a rare but potentially catastrophic injury. The purpose of this study was to review our early clinical results and radiographic morphology of hips treated with a surgical hip dislocation (SHD) approach for intra-articular hip pathology resulting from traumatic instability in pediatric and adolescent patients.
  
  
  METHODS
  This is a retrospective analysis of a consecutive series of patients presenting with nonconcentric reduction after traumatic hip instability. All patients were treated with a transtrochanteric SHD with concomitant procedures based on intra-articular findings. Radiographic evaluations and Harris Hip Scores were completed at final follow-up.
  
  
  RESULTS
  Eleven male patients, mean age of 12.3 years (range, 9.3 to 16.1 y) and mean body mass index 19.6 kg/m (range, 15.4 to 28.0 kg/m). Intraoperative findings included: labral tear (8), femoral cartilage injury (5), acetabular rim fracture (4), acetabular cartilage delamination (3), loose body (2), and femoral head osteochondral fracture (1). Postoperatively, 1 patient developed a transient peroneal nerve palsy. At a mean 24.5 months (range, 12.0 to 48.1 mo) postoperatively, no hips have radiographic evidence of osteonecrosis. The mean lateral center edge angle was 20 degrees (range, 9 to 38 degrees) with 6 hips of <20 degrees; mean acetabular index 9 degrees (range, -2 to 23 degrees) with 5 hips of >10 degrees; mean α-angle 56 degrees (range, 48 to 62 degrees) with 6 hips of >55 degrees; mean acetabular version 12 degrees (range, 8 to 16 degrees) with 8 hips of <15 degrees. At 1-year follow-up, the mean Harris Hip Score was 95.8 (range, 84.7 to 100).
  
  
  CONCLUSIONS
  Early results suggest that SHD is a safe approach to treat an incomplete reduction following posterior hip instability and is effective for identification and treatment of acute intra-articular pathology. Acetabular dysplasia, relative acetabular retroversion, and/or decreased femoral offset may be risk factors for posterior hip instability in adolescents.
  
  
  METHODS
  Level IV.
authors.affiliation: Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX †Mayo Clinic, Rochester, MN.
authors.forename: David A
authors.initials: DA
authors.lastname: Podeszwa
authors.forename: Adriana
authors.initials: A
authors.lastname: De La Rocha
authors.forename: Annalise N
authors.initials: AN
authors.lastname: Larson
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sucato
mesh_terms: D000293:Adolescent; D002648:Child; D006617:Hip Dislocation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D025981:Hip Injuries / Q000150:complications*; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008297:Male; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome