Traumatic hip dislocations in children and adolescents: diagnostic challenges and the significance of MRI imaging-a multi-center study.

Abstract

Background: Traumatic hip dislocations in children and adolescents are rare but can lead to severe outcomes like avascular necrosis. Delayed reductions, often due to overlooked dislocations in initial imaging, pose a major risk. The variability in symptoms and emergency care challenges early diagnosis. This multi-center study evaluates diagnostic approaches to enhance protocols for identifying traumatic hip dislocations in childhood.

Methods: This retrospective multi-center study included 76 patients (aged ≤ 17 years) with acute traumatic hip dislocations and open growth plates from 16 German hospitals. Patient data and imaging from 1979 to 2022 were analyzed, with statistical evaluation performed using SPSS under ethical guidelines.

Results: X-rays (single and biplanar views) were the primary diagnostic method, utilized in 85% of cases. Dislocations were missed in 12% (9 cases), primarily among children under eight years, with half of those under four. Delayed reductions (15.8%, n = 12) were linked to undetected dislocations in imaging in 9 cases. Conventional X-rays frequently missed dislocations, whereas MRI successfully identified all cases. Among the 76 patients, 54 (71%) had associated injuries, with 57.9% (n = 44) diagnosed exclusively via MRI.

Conclusion: Timely diagnosis of traumatic hip dislocations is crucial, as delays increase the risk of femoral head necrosis. An algorithmic approach is essential for young children, where dislocations may not be readily suspected. MRI is vital in the secondary diagnostic phase, providing superior visualization of associated injuries, including acetabular avulsions and soft tissue interpositions highlighting the need for integration of MRI into a unified diagnostic algorithm for children suspected of such injuries.

Level of evidence: IV.