title: Surgical Hip Dislocation for the Treatment of Intra-Articular Injuries and Hip Instability Following Traumatic Posterior Dislocation in Children and Adolescents.
abstract: BACKGROUND
  Traumatic posterior hip dislocation in children is a rare injury that typically is treated with closed reduction. Surgical treatment is typically recommended for nonconcentric reduction with joint space asymmetry with entrapped labrum or an osteochondral fragment. The surgical hip dislocation (SHD) approach allows for full assessment of the acetabulum and femoral head and has been our preferred surgical strategy. The purpose of this study was to (1) describe the intra-articular pathologic findings seen at the time of SHD; and (2) to investigate hip pain, function, and activity level of a cohort of children and adolescents after open treatment of a posterior hip dislocation using the SHD approach.
  
  
  METHODS
  Following IRB approval, 23 patients who sustained a traumatic posterior hip dislocation between January 2009 and December 2013 were identified. In 8/23 (34.8%) patients there was evidence of nonconcentric reduction after closed treatment and surgical treatment was performed using the SHD approach. Seven male and 1 female (mean age, 11.2 y; range, 6 to 14.6 y) were followed for an average of 28 months (range, 13 to 67 mo). The modified Harris Hip Score (mHHS) and the University of California Los Angeles activity score assessed clinical hip outcome and activity level at minimum of 1 year after surgery.
  
  
  RESULTS
  Six patients were treated after an acute trauma, whereas 2 were treated after recurrent dislocations. Five patients were involved in motor vehicle accidents and 3 in sports-related injuries. Intraoperative findings include posterior labral avulsion in all patients, fracture of the cartilaginous posterior wall (n=3), and femoral head chondral injuries (n=5) and fracture (n=1). The labral root was repaired using suture anchor technique in 7/8 patients and resected in 1. In 2 patients, labral repair was complemented by screw fixation of the posterior wall. All but one patient (mHHS=94) reported maximum mHHS. The University of California Los Angeles activity score was 10 for 5/8 patients and 7 in 3 patients. No case of femoral head osteonecrosis was noted. One patient developed an asymptomatic heterotopic ossification.
  
  
  CONCLUSIONS
  When open reduction is recommended for the treatment of intra-articular pathologies and hip instability following traumatic dislocation of the hip in children and adolescents, the SHD is an excellent approach that allows surgical correction of the damaged bony and soft-tissue structures including repair of the capsule-labral complex, and reduction and internal fixation of the cartilaginous posterior wall and femoral head fractures.
  
  
  METHODS
  Level IV.
authors.affiliation: Children's Hospital Colorado, Aurora, CO.
authors.forename: Eduardo N
authors.initials: EN
authors.lastname: Novais
authors.forename: Travis C
authors.initials: TC
authors.lastname: Heare
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hill
authors.forename: Stephanie W
authors.initials: SW
authors.lastname: Mayer
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging*; D000293:Adolescent; D002648:Child; D000072700:Conservative Treatment / Q000009:adverse effects / Q000379:methods; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging*; D050723:Fractures, Bone / Q000601:surgery; D006617:Hip Dislocation / Q000175:diagnosis / Q000601:surgery; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000209:etiology; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000209:etiology; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D009999:Ossification, Heterotopic / Q000175:diagnosis / Q000209:etiology; D016896:Treatment Outcome