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Missed Pediatric Traumatic Hip DislocationA Case Report
Lindsay E. Hickerson, MD1; H. Robert Tuten, MD2
1 Department of Orthopaedics, Virginia Commonwealth University, West Hospital, 9th floor, 1200 East Broad Street, Richmond, VA 23298. E-mail address: lindsayehickerson@gmail.com
2 Tuckahoe Orthopaedic Associates, Ltd., 1501 Maple Avenue, Suite 203, Richmond, VA 23226. E-mail address: roberttuten@comcast.net
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Investigation performed at the Department of Orthopaedics, Virginia Commonwealth University, and Tuckahoe Orthopaedic Associates, Ltd., Richmond, Virginia

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Jan 09;3(1):e2 1-6. doi: 10.2106/JBJS.CC.L.00037
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While traumatic hip dislocation is an uncommon injury in children, it is believed that urgent reduction within six hours of injury reduces the risk of osteonecrosis of the femoral head1. Mehlman et al. reported that there is a twentyfold increased risk of osteonecrosis, which becomes radiographically apparent within twelve months after dislocation, when reduction takes place more than six hours after injury2. Reduction should be performed with caution; adequate muscle relaxation is important because there is increased risk of femoral epiphysis displacement or epiphysiolysis without anesthesia3. Postreduction radiographs should be critically analyzed for concentric reduction since subtle incongruence often reflects entrapped soft tissue and the need for open reduction.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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