Fracture Dislocations of the Hip in Children: A Case Report

Fracture Dislocations of the Hip in Children: A Case Report

Among the injuries that someone could sustain in a car accident, fracture dislocations of the hip are both common and severe. This can inhibit someone's ability to move effectively and could even make it difficult to exit the vehicle in the event of an accident.

There are many different types of auto accidents, and they can range widely in their severity from single-car scrapes to massive multi-vehicle pileups. Someone involved in a car crash can suffer from several different types of bone fractures, including pelvic injuries and hip dislocations. When people see an accident about to happen in front of them, they often slam on their brakes with extreme force, trying to get their car to stop and avoid the objects and cars in front of them. This locks out their knees at the front of the vehicle. When their car collides with the vehicle in front of them, their legs do not bend to absorb the force because they have been locked out. The force starts at the bottom of their feet and transmits through their legs and into their hips, causing a severe injury. In many cases, the head of the femur is forced through the hip socket and out the back of the hip. This leads to a femur fracture but also a hip dislocation and, in many cases, a hip fracture. This is termed a fracture dislocation of the hip and can be a severe or even life-threatening injury.

A Case Report: Open Hip Fracture Dislocations

A team of medical professionals published the case of a 15-year old female who was involved in an auto accident and sustained polytrauma. Among her numerous injuries was a serious fracture dislocation of the hip. She was rapidly transported to the emergency room where she was scanned, and her various injuries were diagnosed. She had a severe fracture dislocation of her hip and was transported to the operating room rapidly for emergent treatment. There was blood on hold for a transfusion in the operating room just in case. The fractures were repaired, and the head of the femur was placed in the appropriate location in the hip socket. After the procedure, she had to undergo an extensive amount of physical therapy and treatment to learn how to walk again. The case report went on to discuss several other facets that people should be aware of regarding this type of injury.

Proper Management is Vital for the Avoidance of Complications

When people sustain a fracture dislocation of their hip in the pelvis, there are a handful of complications that could happen. The most notable complication that the report addresses is necrosis of the head of the femur. This occurs when someone develops avascular necrosis of the hip. This is a serious complication where the blood vessels that feed the head of the femur are severed in a traumatic injury. In this situation, the femur is deprived of all of the important nutrients supplied by the vessels and patients could be forced into an emergency hip replacement. Another notable complication that can happen is a bone infection of the hip joint and socket itself, called osteomyelitis. This infection develops when the wound has been exposed for an extended period of time and bacteria are allowed to colonize the area. This can happen either at the scene of the auto accident or from a complication due to surgery. Patients could require an extended course of antibiotics. This could keep them in the hospital for weeks on end in addition to possibly requiring an extra trip to the operating room for debridement of the wound.

Moving Forward: Management of Injuries in the Future

This case resulted in a successful procedure and recovery. However, several lessons can be taken from this case. The first is that speed is important in traumatic injuries such as this hip fracture dislocation. If the patient is quickly diagnosed, treatment can start immediately. This also allows for any complication or ancillary injuries to be caught early in the process as well. The second is that this injury can be more serious in kids. When kids have leg injuries, it is possible that the growth plates could be damaged. If they are, their legs can grow unevenly, resulting in leg-length discrepancies. This can lead to major quality of life issues down the road.

Image Attribution: The x-ray image at the top has been reproduced under the Universal Creative Commons License, version 2.0. The picture was first found on Wikimedia Commons.
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