Fracture Guideline Index
See also:
Hip dislocation - Emergency Department
- How often should these fractures be followed up in fracture clinics?
- What should I review at each appointment?
- What are the potential complications associated with this injury?
- When should I refer for an orthopaedic consultant opinion?
- What are the indications for discharge?
1. How often should these fractures be followed up in fracture clinics?
Fracture type
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First appointment
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Subsequent review appointments
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Discharge advice to parents
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All dislocations
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2 weeks post-reduction with x-ray
Consideration of bone scan done at 3-7 days post-injury to assess vascular status of the femoral head
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At 6 weeks with x-ray then again at 12 weeks with x-ray
Follow-up visits after 6 weeks should be in the consultant clinic
Consider bone scan/MRI at 6-12 weeks to assess for avascular necrosis (AVN) of the femoral head
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Follow-up will be conducted in the consultant clinic. Patients should be followed 1-2 years post-injury before being discharged from care
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2. What should I review at each appointment?
- Check neurovascular status of the affected leg and stability of the joint
- Check there is concentric reduction on the radiograph
- Watch for complications
3. What are the potential complications associated with this injury?
Avascular necrosis (AVN) of the femoral head is the most common complication. This can occur due to disruption of the blood supply to the femoral head as a result of the injury. The risk is reported between 3-15%. The risk has been shown to be significantly higher if the hip is not reduced within 6 hours post-injury.
Other complications are less common, but include nerve injury (2 -10%), femoral head over growth (coxa magna), osteoarthritis (those injuries with acetabular fractures), recurrent dislocation and growth arrest.
4. When should I refer for an orthopaedic consultant opinion?
After the acute management phase (6 weeks), further follow-up visits should be in the consultant clinic.
5. What are the indications for discharge?
These patients should be followed in the consultant clinics after the initial check. Patients without any complications two years post-injury can be discharged from the consultant clinic.
References (Outpatient setting)
McCarthy JM, Noonan K. Fractures and traumatic dislocations of the hip in children. In Rockwood and Wilkins' Fractures in Children, 7th Ed. Beaty JH, Kasser JR (Eds). Lippincott Williams & Wilkins, Philadelphia 2010. p.769-96.
Vialle R, Odent T, Pannier S, et al. Traumatic hip dislocation in childhood. J Pediat Ortho 2005; 25(2): 138-44.