Children in third-world or developing countries often face problems from lack of treatment. In this report, researchers look at the issue of traumatic hip dislocation that goes untreated. What’s the best treatment once the problem is presented?
Options include doing nothing (no treatment) or surgery with a variety of operations to consider. Eighteen children or adolescents in Nepal with neglected, traumatic hip dislocation were treated by open reduction. The results of eight of those children are reported here.
Open reduction is an operation to make an incision and then put the hip back in place. The children ranged in age from two to 16 years old. They came for treatment an average of 12 months after their injuries. All eight patients had signs of avascular necrosis (AVN). AVN is the death of bone cells from a loss of blood supply.
Traction was used at first to try and reduce or reset the hip back in place. This treatment was not successful. Open reduction was the next step. The authors report improved motion and function after the operation. However, normal range of motion was not restored.
AVN did not seem to affect the final outcome. It was more important that the hip was put back in the center of the socket. If the head of the femur (thighbone) wasn’t exactly in the center, other problems developed.
Long-term prognosis for these eight patients remains guarded. If the open reduction doesn’t work, then other (less desirable) surgeries can be considered. For example hip fusion may be needed. Fusion is not the best option in countries where sitting and squatting are part of everyday life.