Review Question - QID 338

After a posterior hip dislocation, post-reduction radiographs must be assessed for joint congruity and articular widening. Persistent joint incongruity is likely to be caused by soft tissue interposition consisting of a torn labrum including the lateral acetabular apophysis. A post-reduction CT can be performed to look for interposed bone/osteochondral elements located within the hip joint. Surgical extirpation of osteochondral fragments is warranted. Since the patient had a posterior dislocation, the posterior structures have already been disrupted, and further disruption of the anterior structures through an anterior approach is not the best choice.

Vialle et al reviewed 35 patients that were seen with a hip dislocation over a 22 year period. Eight patients were found to have post-reduction joint asymmetry and underwent arthrotomy with excision of the osteochondral fragment. Thirty-four of 35 had good or excellent results with one patient suffering poor results and total head AVN after dislocation that was reduced 24 hours later.

Quick and Eastwood state that pediatric pelvic injuries are rare and "there is no substantial evidence base for the surgical treatment of most injuries". In contrast, "there is increasing evidence to support an appropriately prompt and aggressive operative approach to the treatment of femoral neck fractures and other injuries to the hip joint to reduce the incidence of major complications and their accompanying disabilities". The inherent complication of AVN has been found only to be statistically linked to a delay between dislocation and reduction.