Traumatic hip dislocations are challenging in children. They don’t occur very often. And there are many associated injuries that can occur at the same time that go unnoticed at first. A careful examination must be done before any treatment is started.
Associated injuries of the nerves, blood vessels, growth plate, and soft tissues must be identified. In a five-year-old, there is the problem of the growth plate and typical laxity (looseness) of the soft tissues around the hip present in children. For best results, reduction must begin within six hours of the injury.
Reduction refers to putting the round head of the femur (thigh bone) back in to the acetabulum (hip socket). In younger children (up to age 10), gentle traction may be all that’s needed to reduce the hip. This can be done as a closed reduction. With a closed reduction, no surgery is required.
Applying traction and pulling the leg down far enough to reduce it is not always a simple procedure. Femoral head epiphysiolysis can complicate matters. This refers to a fracture and then separation of the epiphysis (growth plate) at the upper end of the femoral head.
If the physician is unaware of the physeal injury and attempts to reduce the hip with a closed reduction technique, the growth plate can get displaced. The result is can be an unstable hip and eventual osteonecrosis (loss of blood supply and death of the bone).
There are many other factors to consider when attempting to reduce a traumatic hip dislocation in a young child. Reduction in the first few hours after dislocation is ideal to prevent other complications. Emergency department personnel are trained and make every effort to minimize problems. Even under the best of circumstances and with the highest trained individuals, successful reduction with a simple closed procedure just isn’t possible.