Hello-
After posting the prior pediatric hip case, I thought I would share this interesting case I saw a while back. I struggled with it at first, so maybe others can learn from it too. The attached skeletal radiology article from 2004 helped me understand this injury and definitely helped me reach the diagnosis on this case.
9 year old with trauma and severe hip pain. Hip felt liked it popped out of place and then relocated. X-rays in ER show the hip is not dislocated but you can appreciate some widening of the left hip joint medially (difficult to call prospectively). CT shows linear ossific fragment in joint space medially. MRI shows the posterior labrum is completely avulsed from the posterior glenoid rim and displaced into the joint, like a big bucket handle fragment. The ossific fragment on CT is actually a piece of the acetabular epiphysis that was avulsed and displaced with the posterior labrum. Also see tearing of the posterior hip capsule. All in keeping with prior posterior hip dislocation and then relocation, with the relocation tearing and "pulling in" the posterior labrum/epiphyseal fragment into the joint space. This was all confirmed surgically. The skeletal radiology case is basically identical to this case. I thought this was a really cool case.
Drew
kid hip dislocation.pptx
Hip Case.pdf
