Dislocation of the hip with traumatic separation of the capital femoral epiphysis: report of a case with successful outcome.

Experience with a successfully treated transepiphyseal fracture-dislocation of the femoral head in a 4-year-old boy, a review of 6 similar injuries from the literature, and consideration of the anatomy of the immature femoral head and neck, suggest that the treatment of choice for this injury is immediate open reduction and internal fixation with a smooth pin followed by cast protection. Contrary to recommendations in the literature, closed manipulation does not seem justified at any time, since it could eliminate residual blood supply to the femoral head by disruption of the soft tissue hinge between the head and neck. In a child, preservation of the blood supply through intra-articular soft parts is even more imperative than in adults.