KidsMD Health Topics

Hip Fracture

  • We treat children's hips from birth through childhood, adolescence and young adulthood. Our decades of experience following our patients into adulthood have taught us that kids' hip problems affect adult hip problems. Our goal is to do everything possible for our patients so that the hip will do fine for a lifetime.

    –Michael B. Millis, MD, professor of orthopedic surgery, Boston Children's Hospital

    If your child or teen has broken his hip, it causes disruption and stress—for your child and the whole family. You’ll have concerns and questions about your child’s pain, treatment, length of recovery, growth plates and many other issues. It may comfort you to know that Boston Children's Hospital is a world leader in orthopedic pediatrics. We specialize in innovative, family-centered care that supports your child and family every step of the way.

    Hip Fracture
    A hip fracture is a partial or complete break in any of the three bones of the pelvis that make up the hip: the illium (upper part), the ischium (lower part) or the central pubis that joins the ischium on either side. Fractures can also occur where the thigh bone (femur) angles into the hip socket (proximal femur fracture), or in the socket (acetabulum) where the thigh bone rotates. Hip fractures are common in the elderly, and rare in children because a child's bones are designed to absorb more force.

    • The most common causes of hip fractures in children are car and bike accidents.
    • Hip fractures in teens are commonly due to sports injuries.
    • Symptoms can include intense pain, swelling, deformity and/or difficulty moving the area.
    • When a hip is fractured, other structures housed by the pelvic bones can get injured, too. These can include:
      • the lower portion of the intestines and rectum
      • the urinary bladder and the reproductive organs
    • Other injuries commonly associated with hip fractures include head injuries and additional fractures
    • Children’s bones heal more quickly than those of adults. Because they heal quickly, they need prompt medical attention to ensure they heal correctly.
    • Doctors must account for growth plates in diagnosing and treating kids’ broken bones.
    • In an open (compound) hip fracture, the bone is visible through the skin; or a deep wound exposes the bone through the skin, increasing the risk of infection.
       

    Note: If your child has an open (compound) hip fracture (the bone is visible through the skin), it’s an emergency. Call 911 immediately.
     

    How Boston Children's Hospital approaches a hip fracture

    While it’s relatively rare for children to have hip fractures, it does happen. And there are important differences in the growing bodies of children, adolescents and young adults that can make individual treatment tricky. Boston Children's experts provide diagnostics and treatments that are tailored to the special needs of young patients from different age groups.

    Whether your child’s hip fracture needs surgery, casting or just observation—you can have peace of mind knowing that the experts in Boston Children’s Orthopedic Center have treated thousands of children with conditions that few pediatric hospitals have seen. As a result, we can provide expert diagnosis, treatment and care for every type, complexity and severity of hip fracture.

    Our center is known for clinical innovation, research and leadership. We offer the most advanced diagnostics and treatments—several of which were pioneered and developed by our own researchers and clinicians.

    One of the first programs. Our Orthopedic Center is one of the world’s first comprehensive pediatric orthopedic programs, and today is the largest pediatric orthopedic surgery center in the United States, performing more than 6,000 surgical procedures each year. Our program, ranked among the top in the country by U.S.News & World Report, is the nation’s preeminent care center for children and young adults with post-traumatic, developmental, congenital and neuromuscular problems of the musculoskeletal system.

    Orthopedic care in lots of places

    Boston Children’s physicians provides orthopedic care—for fractures and other bone problems—at Children’s locations in Lexington, Peabody and Waltham, as well as at our main campus in Boston. Our physicians see patients at Boston Children's Physicians South in Weymouth.

    If you come from far away, we can help

    As an international pediatric orthopedics center, we care for young patients from all over the world. Our International Center assists families residing outside the United States: We facilitate the medical review of patient records; coordinate appointment scheduling; and help families with customs and immigration, transportation, hotel and housing accommodations.

    Hip fracture: Reviewed by Michael B. Millis, MD
    © Boston Children's Hospital, 2011

    Contact Us

    Orthopedic Center
    Boston Children's Hospital

    300 Longwood Avenue
    Fegan 2
    Boston MA 02115
    617-355-6021

  • Take immediate action

    A hip fracture should be treated quickly and correctly—the hip is the body’s connection to the legs and is crucial for movement.

    If you think your child has broken his hip, you should take him to the Emergency Room. If you’re waiting to see your child’s doctor, it may help to use self-care first aid remedies to reduce swelling and pain:

    • rest: Make sure he doesn’t exert his hip without support; he can use crutches or a cane, if it helps.
    • ice: Wrap a towel around ice cubes, an ice pack or a frozen food package to ice the bone for 20 minutes at a time, at two-hour intervals.

    What is a fracture?

    In dealing with your child’s hip fracture, you may want to know the basics about what fractures are, how fractures in a child differ from fractures in adults, and what’s unique about hip fractures.

    Fractures happen when there’s more force applied to the bone than the bone can absorb. If your child has a fracture, it means that his bone has partially or completely broken.

    • A break in a bone usually occurs from trauma, a fall or a direct blow.
    • In a closed fracture, the bone is broken but the skin is still intact.
    • A complete fracture is a fracture involving the entire cross-section of the bone.
    • In an open (compound) fracture, the bone exits and is visible through the skin; or a deep wound exposes the bone through the skin, increasing the risk of infection.

    Note: If your child has an open (compound) fracture (the bone is visible through the skin), it’s an emergency. Call 911 immediately.

    How are kids’ fractures different from those of adults?

    • softer bones: Because children’s bones are softer than those of adults, they tend to absorb force more readily and therefore break less easily.
    • quicker healing: A child’s break heals much faster than an adult’s break. And the younger the child, the faster the healing. This is good news for recovery, but it also means that your child should get medical and/or surgical attention quickly to ensure that it heals in the correct position.
    • growth plates vulnerable: Children have open growth plates (physes)—areas of cartilage from which bone grows—at several sites in the pelvis as well as at the head of the thigh bone. In performing surgery on broken bones in children, surgeons must consider and account for these growth plates.
    • better bone remodeling capacity: Bone remodeling involves the absorption of bone tissue and the simultaneous depositing of new bone; a bone’s continuous self-renewal, self-healing and self-realignment, partially through reorientation of the growth plate. In kids’ fractures, the bone’s remodeling capability is usually very good, so poor alignment (mal-union) is rare.
    • less residual stiffness: Any stiffness from being in a cast readily dissipates in children, whose tissues are more resilient.

    Your child’s hip joint

    The hip joint is one of the body's most reliable structures, providing movement and support without pain or problems in most people for a lifetime. The hip's simple ball-and-socket arrangement—with the ball-shaped head of the thigh bone rotating inside a cup-shaped socket called the acetabulum—usually works well with amazingly little friction and little or no wear.

    The well-fitting surfaces of the head of the thigh bone and the acetabulum, which face each other, are lined with a layer of cartilage, lubricated by a thin film of fluid. Friction inside a normal hip is less than one-tenth that of ice gliding on ice.

    What is a hip fracture?

    A hip fracture is a partial or complete break in any of the three bones of the pelvis that make up the hip: the illium (upper part), the ischium (lower part) or the central pubis that joins the ischium on either side. Fractures can also occur where the thigh bone (femur) angles into the hip socket, or in the socket (acetabulum) where the thigh bone rotates.

    What are kids’ risk factors for kids breaking the hip?

    A child’s risk for developing a fracture increases if he has:

    • trauma from a car crash, accident, sports injury, fall or physical abuse
    • low mineral content in his bones
    • a genetic disorder that affects his bone metabolism and muscle mass
    • endocrine dysfunction
    • poor nutrition and/or is overweight
    • a lack of calcium in his diet
    • a previous history of fracture(s)

    What are the signs and symptoms of a broken hip?

    Common signs and symptoms of a broken hip can include:

    • pain or swelling in the hip or groin
    • an obvious deformity or uneven leg lengths
    • inability to stand or walk
    • limited range of motion in the hip area; outward turning of the leg
    • bruising (may indicate damage to blood vessels)

    FAQ

    Q: What is a fracture? What is a “broken hip?”
    A:
    A fracture is a partial or complete break in a bone. A hip fracture is a partial or complete break in any of the three bones of the pelvis that make up the hip: the illium (upper part), the ischium (lower part) or the central pubis that joins the ischium on either side. Fractures can also occur where the thigh bone (femur) angles into the hip socket (proximal femur fracture), or in the socket (acetabulum) where the thigh bone rotates.

    Q: If my child has a broken hip, will he be OK?
    A:
    The overwhelming majority of children treated for a broken hip at Boston Children’s have corrections that enable their bones to grow normally—so they can walk, play, grow and live active lives. Kids’ bones heal quickly, and usually without complications.

    Q: How does Boston Children’s treat a broken hip?
    A:
    Your child’s doctor may recommend some combination of these treatments:

    • rest and ice packs: reduce swelling, redness and pain
    • medication to:
      • control pain
      • reduce painful muscle spasms
      • prevent infection if the fracture is open
    • pelvic cast or sling: immobilizes the injured area to promote bone alignment and healing, while also protecting the area from motion or impact
    • surgery: usually needed to put broken hip bones back into place
      • surgeon may insert metal screws or pins located inside the bone (internal fixation) or outside the body (external fixation) to hold bone fragments in place to allow realignment and healing
    • physical therapy: may be needed to strengthen the injured area and help it return to full function

    Q: What are the signs and symptoms of a broken hip?
    A:
    Common signs and symptoms of a broken hip can include:

    • pain or swelling in the hip or groin
    • an obvious deformity or uneven leg lengths
    • inability to stand or walk
    • limited range of motion in the hip area; outward turning of the leg
    • bruising (may indicate damage to blood vessels)
       

    Q: If my child has a broken hip, what should I ask my doctor?
    A:
    Some of the questions you may want to ask include:

    • What bone or bones in the hip has my child broken?
    • Are other tests needed to diagnose his fracture?
    • Is there any damage to his blood vessels or nerves?
    • What actions might you take after you confirm a diagnosis?
    • Is this going to affect his growth plate, and his normal growth?
    • How long will it take for him to heal?
    • Will he need rehab or physical therapy?
    • Will there be restrictions on my child’s activities? If so, for how long?
    • Will there be long-term effects? Pain? Arthritis?
    • What is the follow-up care plan?
       

    Q: How is a broken hip usually diagnosed?
    A:
    Testing for a hip fracture—as well as damage to blood vessels, nerves or muscles—can include:

    Q: What is Boston Children’s experience treating broken bones?
    A:
    At Boston Children’s, we’re known for our clinical innovations, breakthrough research and leadership in orthopedics. We offer the most advanced diagnostics and treatments—several of which were pioneered and developed by Boston Children’s researchers and clinicians.

    At our Orthopedic Center or another orthopedic clinical care area (see next question), your child will be seen by an expert team of orthopedic specialists, led by 28 fellowship-trained, board-certified pediatric orthopedic surgeons.

    Causes

    Whether it’s falling off a bike or colliding in sports—active kids can find many ways to break their bones. A hip break is a serious fracture, which usually occurs only if the bone is impacted with tremendous force. Common ways a child could break his hip include:

    • trauma, as from a car crash, accident, physical abuse or contact sports injury
    • falling from a steep height

    Signs and symptoms

    Common signs and symptoms of a broken hip can include:

    • pain or swelling in the hip or groin
    • an obvious deformity or uneven leg lengths
    • inability to stand or walk
    • limited range of motion in the hip area; outward turning of the leg
    • bruising (may indicate damage to blood vessels)

    When to seek medical advice

    A hip fracture should be treated quickly and correctly—the hip is the body’s connection to the legs and is crucial for movement. Consult your pediatrician immediately if your child has:

    • pain or swelling in the hip or groin
    • an obvious deformity or uneven leg lengths
    • inability to stand or walk
    • limited range of motion in the hip area; outward turning of the leg
    • bruising (may indicate damage to blood vessels)

    Questions to ask your doctor

    If your child is diagnosed with a broken hip, you may feel a bit overwhelmed. It can be easy to lose track of the questions that occur to you. Lots of parents find it helpful to jot down questions as they arise—that way, when you talk to your child’s doctors, you can be sure that all your concerns are addressed. If your child is older, he may want to ask questions, too.

    Some of the questions you may want to ask include:

    • What bone or bones in the hip has my child broken?
    • Are other tests needed to diagnose his fracture?
    • Is there any damage to his nerves or blood vessels?
    • What actions might you take after you confirm a diagnosis?
    • Is this going to affect his growth plate, and his normal growth?
    • How long will it take for him to heal?
    • Will he need rehab or physical therapy?
    • Will there be restrictions on my child’s activities? If so, for how long?
    • Will there be long-term effects? Pain? Arthritis?
    • What is the follow-up care plan?

    Who's at risk?

    A child’s risk for developing a fracture increases if he has:

    • a trauma from a car crash, accident, sports injury, fall or physical abuse
    • low mineral content in his bones
    • a genetic disorder that affects his bone metabolism and muscle mass
    • endocrine dysfunction
    • poor nutrition and/or is overweight
    • a lack of calcium in his diet
    • a previous history of fracture(s)
       

    Note: Boston Children’s Bone Health Program provides comprehensive evaluations of children and adolescents who have, or are at risk for, low bone density.

    Complications

    Other injuries. When a hip is fractured, other structures housed by the pelvic bones can get injured, too. These can include the lower portion of the intestines and rectum, the urinary bladder and the reproductive organs. Other commonly associated injuries include head injuries and additional fractures.

    Complications after treatment. Most non-surgical and surgical corrections of childhood fractures occur without complications. Although complications are relatively uncommon, they can occur and can include:

    • osteonecrosis (avascular necrosis): bone death caused by lack of blood supply to the bone. A hip fracture can happen close to the network of blood vessels that go to the head of the femur.
    • growth disturbances: a fracture that extends into the bone’s growth plates in still-growing children can disturb or stop the normal growth of the bone (growth arrest). This can lead to limb length discrepancies or angular deformities. Surgery on broken bones in children must account for these growth plates.
    • post-surgery complications, including:
      • infection
      • damage to blood vessels or nerves

    Long-term outlook

    Our research into bone problems means that we can provide your child with the most innovative care available. As a result, the overwhelming majority of children treated for hip fractures at Children’s have corrections that enable their bones to grow normally—so they can walk, play, grow and live active lives.

    For teens

    If you’re teen with a broken hip, you have a lot to cope with. Besides the typical issues any teenager faces—from social acceptance to body changes and more—you’ll also have to deal with medical appointments and procedures, finding alternative ways to get around, keeping your cast or sling safe, clean and dry, and limiting your activities for a period of time.

    If you’re usually active, to be experiencing pain or sitting on the sidelines for a while can be depressing and frustrating. If you feel down, angry or anxious through this important time in your life, speak to your doctor, parent or counselor to get help—they’re all on your team, and they want to help. And remember that Boston Children’s Orthopedic Center is always here for you, too.

    Prevention

    It’s hard to prevent a child from breaking a bone—especially if your child is very active and plays sports. But the value of kids’ participation in sports and play greatly outweighs the risk of breaking a bone.

    While you can’t prevent your child from breaking a bone, you can help him minimize his risk with simple, common-sense steps:

    • Avoid risky behavior that can result in falls or accidents.
      • See that your child wears proper sports and safety gear, including proper footwear if he is a runner.
      • See that he wears his seat belt in the car.
      • Make sure your baby or toddler is secured in his car seat.
    • Make sure he eats a healthful diet: low in fat, high in protein, nutrients and fiber.
      • Make sure he has plenty of calcium in his diet:
        • Milk, yogurt, cheese, fish, and leafy green vegetables are high-calcium foods
      • Monitor his portions to help him control his weight, since obesity puts him at greater risk for breaking a bone.
        • Limit sodas and sugary snacks.
        • Have regular sit-down mealtimes, and limit his between-meal snacking 
    • Encourage him to get lots of weight-bearing physical exercise.
      • Discourage prolonged time watching TV, playing computer games or other sedentary activities.
      • Encourage your young athlete—especially if he’s a runner—to do some cross-training to decrease the possibility of stress fractures
    • Immediately report any suspicion of physical abuse, or the danger of abuse.

    Center for Young Women’s Health and website for Young Men’s Health

    Why are my friendships changing? How can I convince my parents that being a vegetarian is right for me? What types of birth control are available to me, and how do I use them? Young men and young women have specific concerns about their physical and emotional health. Children’s Center for Young Women’s Health and our website, youngmenshealthsite.org, offer general and gender-specific health information on fitness and nutrition, sexuality, development and emotional health.

  • How do you diagnose a broken hip?

    At Boston Children' Hospital, we know that the first step in treating your child’s broken hip is to form an accurate and complete diagnosis.

    During a physical exam, the doctor obtains a complete medical history of your child and asks how your child got hurt. The physician will look for any injuries commonly associated with hip fractures. These can include injury to any of the structures housed by the pelvic bones, such as the lower portion of the intestines and rectum, the urinary bladder and the reproductive organs. Other commonly associated injuries include head injuries and additional fractures.

    The doctor will examine any lacerations to determine whether an open fracture (bone visible through the skin) has occurred, and will press on front and back of the pelvic area to help determine how stable the hip is. A rectal examination also may be performed to look for hemorrhage that may signify bone penetration into the rectum.

    Other diagnostic tests may include:

    • x-ray: uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film—usually sufficient for the majority of fractures
    • MRI (magnetic resonance imaging): uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body; especially useful for assessing soft tissue around injured joints and bones
    • computed tomography scan (CT, CAT scan): uses a combination of x-rays and computer technology to produce 3-D cross-sectional images (slices), both horizontally and vertically, of the affected area—including bones, fat, soft tissue
    • bone scan: uses a radioactive dye to visualize the bones. It’s different from plain x-rays or CT in that it shows bone metabolism and cell activity in the bones. Bone scans are used to assess bone growth activity, bone remodeling activity and/or blood flow in the affected area(s).

    Our Orthopedic Clinical Effectiveness Research Center (CERC)

    The Orthopedic Clinical Effectiveness Research Center (CERC) was established by the Orthopedic Center to improve the quality of life for children with musculoskeletal disorders. This collaborative clinical research program is unique in the nation and is playing an instrumental role in establishing, for the first time, evidence-based standards of care for pediatric orthopedic patients throughout the world.

  • Take immediate action

    A hip fracture should be treated quickly and correctly—the hip is the body's connection to the legs and is crucial for movement.

    If you think your child has broken his hip, you should take him to the Emergency Room. If you're waiting to see your child's doctor, it may help to use self-care first aid remedies to reduce swelling and pain:

    • rest: Make sure he doesn't exert his leg without support; he can use crutches or a cane, if it helps.
       
    • ice: Wrap a towel around ice cubes, an ice pack or a frozen food package to ice the leg for 20 minutes at a time, at two-hour intervals.

    How we'll treat your child's hip

    Boston Children's Hospital's hip sub-specialists provide comprehensive treatment—including evaluation, diagnosis, consultation and follow-up care—to their young patients. How we'll treat your child's hip fracture depends on the location, complexity and severity of his break—as well as his age and overall health. Boston Children's orthopedic experts will provide comprehensive treatment—including evaluation, diagnosis, consultation and follow-up care.

    Our treatment goals are to:

    • control your child's pain
    • promote healing
    • prevent complications
    • restore normal use of the fractured area


    To restore your child's use of his broken hip bone, his doctor may recommend some combination of these possible treatments:

    • rest and ice packs to reduce swelling, redness and pain
    • medication to:
    • surgery: usually needed to put broken hip bone(s) back into place
      • in open reduction, the surgeon inserts metal screws and pins (internal fixation) to hold bone fragments in place to allow alignment and healing
    • pelvic cast or sling: immobilizes the injured area to promote bone alignment and healing, while also protecting the injured area from motion or impact; at Children's, our experts fit your child for his cast or sling
    • physical therapy: may be needed to strengthen your child's muscles and help his hip return to full function

    Care after surgery: tips if your young child is in a cast

    • Keep your child's cast clean and dry.
    • Check for cracks or breaks in the cast.
    • Put pads on rough edges to protect the skin from scratches.
    • Don't scratch the skin under the cast by inserting objects inside the cast.
    • Use a hairdryer placed on a cool setting to blow air under the cast and cool down the hot, itchy skin. Never blow warm or hot air into the cast.
    • Cover the cast while your child is eating to prevent food spills and crumbs from entering the cast.
    • Prevent small toys or objects from being put inside the cast.
    • Elevate the cast to decrease swelling.
    • Encourage your child to move his toes to promote circulation.

    Healing time after treatment

    A hip fracture is a serious injury, and it usually means that your child will need surgery. There may be exceptions, but as a general guideline, the younger the child, the quicker he'll heal.

    • Children and teens typically need to be in a cast for four to six weeks after surgery.
    • Infants, toddlers and very young children who are treated non-surgically with a hip spica cast (a cast that includes the trunk of the body and one or more limbs) often need less time to heal.

    Coping and support

    If your child or teen is being treated for a broken hip, the best thing you can do for him is to keep and model a positive attitude. Make a game out of keeping your small child's cast dry during bathing. Start a countdown calendar for your teen to help him see progress toward getting back to normal—and toward getting back into his game if he plays sports.

    Still, we understand that a hospital visit can be difficult. So, we offer many amenities to make your child's—and your own—hospital experience as pleasant as possible. Visit the Center for Families for all you need to know about:

    • getting to Boston Children's
    • accommodations
    • navigating the hospital experience
    • resources that are available for your family

    In particular, we understand that you may have a lot of questions when your child is diagnosed with a hip fracture. Will my child need surgery? How long will his recovery take? Will it affect my child long term? What should we do at home? Children's can help you connect with extensive resources to help you and your family through this stressful time, including:

    • patient education: From doctor's appointments to treatment to recovery, our nurses and physical therapists will be on hand to walk you through your child's diagnosis, treatment and recovery. And once your child is home, we'll help you coordinate and continue the care and support he received at Children's.
       
    • parent-to-parent: Want to talk with someone whose child has been treated for hip dysplasia? We can often put you in touch with other families who've been through the same experience that you and your child are facing.
       
    • faith-based support: If you're in need of spiritual support, we'll connect you with the Boston Children's chaplaincy. Our program includes nearly a dozen clergy—representing Protestant, Jewish, Muslim, Catholic and other faith traditions—who will listen to you, pray with you and help you observe your own faith practices during your child's hospital experience.
       
    • social work: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to coping with illness and dealing with financial issues.

    A long line of orthopedic firsts

    With a long history of excellence and innovation and a team of clinicians and researchers at the forefront of orthopedic research and care, Boston Children's is home to many treatment breakthroughs:

    • advanced techniques and microsurgery care for complex fractures and soft tissue injuries to the hand and upper extremity
    • one of the first pediatric sports medicine clinics in the nation
    • a hip program that has performed more than 1,400 periacetabular osteotomies
    • advances in our spinal program, such as video-assisted thorascopic surgery

    Boston Children's is also:

    • the oldest and largest comprehensive center for the care of spina bifida
    • one of the first scoliosis clinics in the nation

    one of the first centers in the nation to use adjuvant chemotherapy and perform limb salvage surgery for patients with osteosarcoma.

  • For more than a century, orthopedic surgeons and investigators at Children’s Hospital Boston have played a vital role in the field of musculoskeletal research—with breakthrough treatments and major advances for conditions such as developmental hip dysplasia, scoliosis, polio, tuberculosis and traumas to the hand and upper extremities.

    Our pioneering research helps answer the most pressing questions in pediatric orthopedics today—to provide children with the most innovative care available.

    In Boston Children’s Orthopedic Center and Child and Young Adult Hip Preservation Program, we take great pride in our basic science and clinical research leaders, who are recognized throughout the world for their achievements. Our orthopedic research team includes:

    • full-time basic scientists
    • more than 20 clinical investigators
    • a team of research coordinators and statisticians

    New trauma/ER database

    Under the direction of Travis Matheney, MD, Boston Children’s database of orthopedic ER trauma cases—implemented in July, 2010—has begun outcomes research, in which we track/compile orthopedic trauma data, such as:

    • type and location of a fracture
    • outcome (quality improvement)
    • whether the injury required admission to the hospital
    • how was the injury initially treated
       

    The information gathered from this ongoing tracking study will further influence how specialists in Boston Children’s Orthopedic Trauma Program care for children by providing accurate, comprehensive tracking and outcomes data.

    Studies of developmental hip conditions

    Developmental hip conditions such as hip dysplasia, slipped capital femoral epiphysis and Legg-Calve-Perthes disease can lead to premature arthritis in young adults with resulting pain and disability. Our research focuses on understanding the pathomechanics (mechanical forces that adversely change the body's structure and function) of these conditions. With better understanding, we can improve existing therapies and develop new therapies for these complex conditions.

    Current and recent studies include:

    • We’re conducting a large number of ongoing studies to follow patients who’ve had various treatments for hip problems. Our studies use outcomes measures, custom questionnaires and special methods for measuring results—both prospectively (before treatment) and retrospectively.

    For example, femoral acetabular impingement (FAI) is a research topic that Children’s is working on extensively. FAI is a “bump” on the neck of the femur that permanently remains as a result of SCFE. The impingement can be small (causing no additional damage) or larger (creating cumulative damage to the cartilage inside the hip and resulting in arthritis). In a long-term study, our researchers are investigating the effectiveness of removing the bump at the time of surgery.

    • We’re studying long-term outcomes after Bernese periacetabular osteotomy (Bernese PAO) for hip dysplasia: Since 1991, Boston Children's has performed more than 1,400 Bernese periacetabular osteotomies to correct dysplastic hips in teens and adults, whose hip sockets have finished growing. This large volume makes Children’s the most experienced center in the United States for this procedure—and the second-most experienced in the world.

      PAO is our standard treatment for a hip socket that’s too shallow in a patient whose socket has finished growing—typically ages 13 or 14 through adult—and whose hip is still viable enough to be repaired rather than replaced. The procedure rotates the hip socket into a more stable position and is the most complex and powerful procedure for positioning the hip socket.

      We’re constantly obtaining and analyzing radiographic and clinical long-term follow-up data on sub-groups of our PAO patient population as it ages, to determine the effectiveness of the procedure for halting or preventing the development of osteoarthritis of the hip.
    • We’re studying the use of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) to assess early osteoarthritis in dysplastic hips: In early osteoarthritis, the charge of the extracellular matrix is degraded and lost. The delayed gadolinium-enhanced MRI of cartilage technique is designed to indirectly measure the early loss of charge density in cartilage.
    • We’re studying perfusion MRI as a predictor for developing avascular necrosis after closed reduction of dislocated hips: Our retrospective analysis is looking at predictive values of contrast-enhanced MRI after closed reduction for avascular necrosis (cellular death due to interrupted blood supply) in developmental dysplasia of the hip.
    • Boston Children’s is a founding member of the Academic Network of Conservational Hip Outcomes Research (ANCHOR), a collaboration of researchers dedicated to following patients with developmental hip disease. The group now comprises 10 centers in the United States and one in Europe, and enrolls more than 500 patients each year in various studies.

    Clinical Effectiveness Research Center

    Children’s Orthopedic Clinical Effectiveness Research Center (CERC) helps coordinate research and clinical trials to improve the quality of life for children with musculoskeletal disorders. This collaborative clinical research program is unique in the nation and plays an instrumental role in establishing—for the first time—evidence-based standards of care for pediatric orthopedic patients throughout the world.

    Major areas of focus for the CERC include:

    • brachial plexus birth palsy
    • hip disorders
    • spinal disorders
    • trauma/fractures
    • upper extremity disorders

    Ongoing laboratory studies include:

    • Basic science studies
    • Biomechanical/instrumentation studies
       

    Orthopedic basic science laboratories

    Working in Boston Children’s labs are some of the leading musculoskeletal researchers in the nation. Our labs include:

    Children speak about what it's like to be a medical research subject

    View a video of a day in the life of Boston Children’s Clinical and Translational Study Unit, through the eyes of children who are “giving back” to science.

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This department is currently not accepting appointment requests online. Please call us at: 617-355-6000. International +1-617-355-6000.

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The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO
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