Avascular Necrosis of the Femoral Head After Recurrent Traumatic Posterior Hip Dislocation in a 10-Year-Old Girl: A Case Report

Abstract

Background: Traumatic hip dislocation (THD) is a rare pathology in the pediatric population. The severity of the trauma, mismanagement, or late treatment of such pathology can lead to complications, including avascular necrosis (AVN) of the femoral head. We hereby report a case of recurrent traumatic posterior hip dislocation that eventually lead to AVN of the femoral head in a 10-year-old girl. Case presentation: A 10-year-old girl presented to the Emergency Department complaining of left hip pain one day following a fall from a standing position. On physical examination, the left hip was held in the position of flexion, adduction, and internal rotation, with complete loss of range of motion of the left hip joint. Radiographic imaging was done and showed: a posterior dislocation of the left hip, enlargement of the growth cartilage of the left femoral epiphysis, and hypertransparency of the anterosuperior corner of the left femoral neck, and increased bone density of the upper left femoral epiphysis, suggesting previous hip dislocations. Open reduction with arthrotomy and posterior capsulorrhaphy was performed 36 hours post-injury, followed by hip immobilization by a spica cast. Two months after surgery, the cast was removed. On examination, the left hip was stable with good mobility, and weight-bearing was authorized. Follow-up was done three months post-injury. The patient had no complaints, but radiographic images showed signs of avascular necrosis (AVN) on the left femoral head.  Conclusion: Our case emphasizes the importance of early diagnosis and management of a THD in pediatrics, to prevent serious complications such as AVN.