V G. Goni, A RHH, B Saibaba, P Sudesh (Chandigarh – Inde)
Traumatic dislocations of the hip in children are on the rise in this fast developing world due to a concurrent increase in the number of high-velocity road traffic accidents. Anterior dislocation of the hip has a lower incidence compared to posterior dislocation of the hip. We came across a rare case of the obturator type of anteriorly dislocated hip associated with ipsilateral fracture of shaft femur in an 11-year-old child. This is a highly unusual injury combination and the mechanism of injury is obscure. Only two similar cases have been reported in the English literature till now. Closed reduction of the hip using a hitherto undescribed technique and the intramedullary interlocking nail was performed in this case. At 6 months follow-up, the fracture shaft femur has united and the child is bearing full weight on the limb.
One must always be aware of the possibility of the hip being dislocated anteriorly in children with ipsilateral hip dislocations and shaft femur fractures as this injury combination is quite rare. If diagnosed correctly and in time, the management is straightforward. Hip reduction if not achieved with ease, can be reduced using our “semi-invasive” technique of applying an external fixator unit following which the shaft femur fracture must be reduced and fixed using a technique which is most appropriate to the age of the child and fracture pattern and characteristics which might vary from hip spica to intramedullary nailing.