Retrospective Study of Pediatric Hip Dislocations and Proposal of a Novel Classification System for Risk Assessment

Introduction: Traumatic hip dislocations in children are rare but carry high morbidity due to risks such as avascular necrosis (AVN) and post-traumatic arthritis.Existing classification systems are designed for adults and fail to account for pediatric-specific factors, such as ongoing skeletal maturation.This study aimed to characterize pediatric hip dislocations from a single level I trauma center, evaluate associated complication risks, and propose a novel classification system for the pediatric population.Materials and methods: We conducted a retrospective cohort study of patients aged 2-18 years with traumatic hip dislocations treated between January 2015 and January 2025 at a single level I pediatric trauma center.Demographics, mechanism of injury, associated injuries, reduction details, and outcomes were all analyzed.Patients were categorized into four proposed types based on mechanism, time to reduction, method/location of reduction, and associated injuries.Statistical analysis included descriptive statistics, chi-squared or Fisher's exact tests, and ANOVA with significance set at p < 0.05.Results: Thirty-four patients met the inclusion criteria.The mean age of patients was 13.7 ± 3.4 years, with a mean follow-up of 13.9 months (minimum six months).We found that posterior acetabular fractures were significantly more common in high-energy injuries than in falls (p = 0.025).Our institution's median time to reduction was 6.5 hours, with no significant association between time to reduction and development of complications like AVN or arthrofibrosis.Classification type was significantly associated with skeletal maturity (p = 0.049), whereas no significant association was observed with BMI (p = 0.749).Conclusions: Pediatric hip dislocations demonstrate distinct injury patterns influenced by maturity, BMI, and mechanism.Our proposed classification system provides a pediatric-specific framework for describing injury patterns and treatment complexity.Further prospective and external validation is required to determine whether classification type has predictive value for clinical outcomes or management.