. 122 .
Chinese Journal of Traumatology 2013;16(2):122-125
Traumatic anterior hip dislocation in a 12-year-old child
Vinay Gupta*, Maneet Kaur, Zile Singh Kundu, Aseem Kaplia, Deepinderjit Singh
【Abstract】Hip dislocation in children can occur
congenitally in isolation or in conjunction with other con-
genital abnormalities. Traumatic hip dislocations in children
are relatively uncommon and anterior dislocation of hip joint
is even rarer. We report such a case following unusual mode
of injury in a 12-year-old child. The patient underwent suc-
cessful emergent closed reduction of left hip. The clinical
P
ediatric hip can be commonly congenitally dis-
located in isolation or in conjunction with other
congenital abnormalities such as Down
syndrome, Ehlers-Danlos syndrome, Weaver syndrome,
Prader-Willi syndrome etc.1-6 Traumatic dislocation of
the hip is a presentation most associated with adult
patients involved in high-energy trauma. Traumatic hip
dislocation in children is relatively uncommon and an-
terior dislocation of the hip joint is even rarer. In adults
a significant amount of force is required to disrupt the
tough ligamentous capsule that contributes stability to
the most stable joint in the body. However, a much
lower energy is required for dislocation of the hip in
children. We report such a case following unusual mode
of injury in a 12-year-old child without any associated
injuries or comorbid condition.
The informed consent was taken prior to being in-
cluded into the study. The study was authorized by the
local ethical committee and performed in accordance
with the Ethical standards of the 1964 Declaration of
DOI: 10.3760/cma.j.issn.1008-1275.2013.02.012
Department of Orthopaedics, Fortis Healthcare, Mohali,
India (Gupta V, Kaplia A)
Department of Emergency Medicine, Dayanand Medi-
cal College & Hospital, Ludhiana, India (Kaur M)
Department of Orthopaedics, Pandit Bhagwat Dayal
Sharma Post Graduate Institute of Medical Sciences,
Rohtak, India (Kundu ZS)
Department of Orthopaedics, Maharishi Markande-
shwar Medical College & Hospital, Kumarhatti Solan,
Himachal Pradesh, India (Singh D)
*Corresponding author: Tel: 91-9996193439, Email:
drvinaygupta15@yahoo.co.in
course and follow-up assessment of the patient was other-
wise uneventful. At 2 years’ follow-up there was no evi-
dence of osteoarthritis, coxa magna, heterotrophic
calcification, in congruency of the joints or avascular ne-
crosis of the head of femur.
Key words: Hip; Dislocations; Child
Chin J Traumatol 2013;16(2):122-125
Helsinki revised in 2000.
CASE REPORT
A 12-year-old boy fell while catching kites from stairs
and got his left foot entangled in the staircase causing
hyperabduction injury to left lower limb. After being ad-
mitted to casualty, on clinical examination he was fully
conscious and orientated. The vital signs and exami-
nation of the head and neck, chest, abdomen and spine
were normal. His left hip was abducted, flexed and ex-
ternally rotated (Figure 1). Distal circulation and neu-
rology in both lower limbs were normal as well. There
were minor abrasions over the left foot. There was no
history of previous dislocations or joint laxity. Clinico-
radiological examination was not suggestive of any fea-
ture of developmental dysplasia of the hip, but showed
hip dislocation with the femoral head displaced
anteroinferiorly on the left side (Figure 2). There was no
associated fracture of the acetabulum or femur.
The hip was reduced under emergency intravenous
sedation within two hours of the injury. The left hip was
reduced with in-line traction and support of the pelvis
with a laterally directed force at the proximal femur.
After reduction, the left hip was noted to be stable
throughout a physiologic range of motion. The post-
reduction radiographs showed the hips in anatomical
position (Figure 3). Post-reduction neurological exami-
nation did not demonstrate any motor weakness or loss
of sensation.
The patient was kept on skin traction for two weeks
Chinese Journal of Traumatology 2013;16(2):122-125
and active range of hip motion exercises were com-
menced thereafter. He was allowed to weight bearing
as tolerated with supervised physiotherapy. Full weight
bearing was commenced at 3 weeks. Full movements
were regained in both the hips and the patient was
asymptomatic with full range of motion. The patient
could squat and sit cross legged and ambulate without
support. At 2 years’ follow-up there was no shortening
and full range of movement was achieved. Radiographs
were normal with no evidence of osteoarthritis, coxa
magna, heterotrophic calcification, in congruency of the
joints or avascular necrosis of the head of femur.
Figure 1. Clinical photograph showing anterior dislocation of limbs.
Figure 2. X-ray showing anteroinferior dislocation of left hip.
Figure 3. A: Clinical photograph after closed reduction of left hip.
B: Pelvis X-ray showing concentric closed reduction.
. 123 .
DISCUSSION
The hip joint is a true ball-and-socket joint in which
the head is incompletely covered. Because of the depth
of the acetabulum enhanced by the labrum, and its thick
capsule and strong muscular support, the hip joint is
less likely to dislocate than any other joint in the body.
The ligamentous support is provided by strong capsu-
lar ligaments that run from the acetabulum to the femo-
ral neck and the intertrochanteric region. The iliofemo-
ral ligament is located anteriorly and ischiofemoral liga-
ment is located posteriorly. The short external rotators
adhere to the capsule posteriorly, providing additional
stability.8,9 A significant amount of force is required to
disrupt the tough ligamentous capsule that contributes
stability to the most stable joint in the body. However,
a much lower energy is required for dislocation of the
hip in children. Hip dislocations in children are rela-
tively uncommon, accounting for less than 5% of hip
dislocations. They can occur in young children below 5
years old as a result of seemingly trivial trauma.10-12
Osteonecrosis of the femoral head occurs after simple
dislocation of the hip in an estimated 10% to 26% of
adults and 8% to 10% of children.13 The child's acetabu-
lum at that age is primarily soft and pliable cartilage,
and there is generalized ligamentous laxity that allows
hip dislocation. Dislocations in older children usually
require significant trauma because the acetabulum is
bony as well as less resilient and the ligaments are
stiffer.10-12
Hip dislocation in children is generally classified as
anterior or posterior depending on where the femoral
head lies after dislocation. Posterior dislocation is much
more common than anterior dislocation and tends to
occur as a result of an axial force on the femur applied
toward the hip with the hip in flexion. Dashboard injury
is a frequent cause. The limb assumes a position of
shortening, internal rotation and adduction. Anterior dis-
location can occur superiorly or inferiorly and results
from forced abduction and external rotation. In
extension, the hip tends to dislocate anteriorly and
superiorly. The limb appears shortened, the thigh is
positioned in external rotation and extension and the
femoral head is palpable in the groin. If the hip dislo-
cates with the leg flexed, the femoral head tends to
dislocate inferiorly. The leg is held in abduction, exter-
nal rotation, and flexion, and the femoral head is pal-
pable near the obturator foramen.7
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