hip dislocations are mostly due to low velocity injury in children younger than 3 years .
a 25 month old child presented to our casualty following a fall from a slide 3 hours prior to presentation .
an x - ray of the pelvis was taken which showed a posterior hip dislocation on the right side .
the child had an emergency closed reduction under general anaesthesia followed by a broom stick plaster cast with hips in 30 abduction .
the child was reviewed at 6 and 18 months with mri scans at 6 and 18 months .
paediatric hip dislocation ( less than 3 years of age ) is a very rare entity whose incidence is on the rise due to the increase in road traffic accidents .
the key stone in proper management is clinical suspicion , early recognition and promptreduction ( within 6 hours ) .
also gentle manipulation during reduction has a definite role in preventing iatrogenic chondrolysis and osteonecrosis of femoral head .
the periosteum is thick in children , the bones are soft and elastic and can absorb quite some force because of the soft spongy nature . hence dislocations are rare in paediatric age group . however with the increasing number of motor vehicles plying on our roads and the ever present risk of road traffic accidents , there is a recent change in the above trend .
most of the paediatric injuries are the result of low velocity accidents . in case of high velocity injuries
there has been case reports of traumatic hip dislocations in childhood mostly in the western world .
most of the published articles in literature include the adolescent population ( 12 - 17 years ) .
there are very few case reports of such dislocations in children < 3 years . here
we present a case report of a child ( age 25 months ) with traumatic posterior dislocation of the hip following low velocity injury .
a 25 month old male child presented to our casualty following a slip and fall from a slide while playing in a park .
he had severe pain in the right hip and limb was adducted and internally rotated .
an emergency radiograph of the pelvis taken in emergency showed a posterior dislocation of his right hip[fig.1 ] .
gentle traction with minimal rotation was sufficient to achieve reduction , the congruency of which was checked under image intensifier .
once congruency was confirmed , an above knee broom stick plaster was applied to both lower limbs with hips in 30 abduction .
check radiographs[fig.2 ] was taken along with a mri[fig.3 ] of the hip to check if there was any traumatic injury to the physes .
he was kept on the plaster for 6 weeks following which plaster cast was removed and child mobilized with as tolerated weight bearing .
follow - up x - ray was taken at 6 weeks[fig.4 ] and serial mri scans taken at 6 and 18 months [ fig.5 & fig.6 ] showed no chondrolysis or osteonecrosis .
he had restriction of flexion of knee beyond 120 at 6 weeks which improved to 140 by 8 weeks .
x - ray following closed reduction and plaster application showing concentric reduction . mri taken immediately following closed reduction showing minimal marrow edema in head and neck area .
x - ray taken at 6 weeks following removal of plaster cast showing stable hip with no re - dislocation .
m r i at 6 months showing normal physeal plate with no avn m r i at 18 months showing normal femoral head anatomy and physes
however with the everpresent danger of motor vehicle accidents in our crowded and chaotic roads , this rarity may become more common . in most children however , hip dislocations are mostly due to low velocity accidents which occur during playing .
there are a few reports in western literature of hip dislocation in peadiatric population , most of them are case reports .
there has been only two case reports of children less than 3 years with hip dislocation .
also most of the reports emphasizes the need to do urgent reduction within the golden period ( i.e 6 hours ) .
the risk of osteonecrosis in one study was 5.7% in acute cases vs 47.8% in old neglected cases undergoing reduction procedures .
the severity of the injury is also an important predictor for the development of osteonecrosis . also important
is that during closed reduction , care is to be taken not to perform forceful manipulation as this greatly increases the risk of iatrogenic physeal separation .
as is with our case gentle traction with minimal rotation is enough to reduce the joint .
the method of immobilization varies with the authors from skin traction to plaster cast application but we found that results with plaster cast are more predictable with better patient cooperation .
child abuse is also a possible etiology of hip dislocation in children when a child presents with a doubtful history and injuries in various stages of healing . in our patient ,
the immediate post - reduction mri showed a small linear posterior labral tear which had healed in subsequent mri scans taken at 6 months
in literature there are case reports of traumatic hip dislocations in childhood ( < 3 years ) in the western archives . here
we present a case report of a traumatic hip dislocations in a child < 3 years in indian population .
paediatrichip dislocations are a medical emergency which requires a great deal of suspicion to detect early and treat appropriately .
our patient had excellent recovery and functional outcome because of early reduction within the  golden period  ( 6 hours ) .
although he had a labral tear , the soft tissues healed with immobilisation without any further intervention with no permanent disability .
we therefore conclude that traumatic hip dislocations in children < 3 years is an uncommon injury but a keen lookout is a must for early diagnosis and treatment .
however a high degree of suspicion combined with early and prompt reduction is the keystone in management .
this is to ensure a good functional outcome and prevention of complications like osteonecrosis and chondrolysis .
 introduction : hip dislocation in a child less than 3 years is a very rare event . 
 only a few case reports have been documented in western literature . 
 it is rarely reported from indian population . 
 hip dislocations are mostly due to low velocity injury in children younger than 3 years . 
 we report such a case of hip dislocation in a 2 year old child.case report : a 25 month old child presented to our casualty following a fall from a slide 3 hours prior to presentation . 
 his right lower limb was adducted and internally rotated . 
 there was severe pain on attempting movements . 
 an x - ray of the pelvis was taken which showed a posterior hip dislocation on the right side . 
 the child had an emergency closed reduction under general anaesthesia followed by a broom stick plaster cast with hips in 30 abduction . 
 congruency of reduction was checked with image intensifier before plaster application . 
 the plaster was removed at 6 weeks and gradual weight bearing started . 
 the child was reviewed at 6 and 18 months with mri scans at 6 and 18 months . 
 there were no signs of avascular necrosis or chondrolysis.conclusion:paediatric hip dislocation ( less than 3 years of age ) is a very rare entity whose incidence is on the rise due to the increase in road traffic accidents . 
 the key stone in proper management is clinical suspicion , early recognition and promptreduction ( within 6 hours ) . 
 also gentle manipulation during reduction has a definite role in preventing iatrogenic chondrolysis and osteonecrosis of femoral head . 
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Case Report:
Conclusion:
Introduction
Case report
Discussion
Conclusion