Surgical Repair of Traumatic Hip Dislocations With Acetabular “Fleck” Signs

Surgical Repair of Traumatic Hip Dislocations With Acetabular “Fleck” Signs 1024 683 Mary Bates, PhD
Kevin Klingele, MD

Surgical hip dislocation with open labral repair produced excellent clinical outcomes in pediatric patients.

The acetabular “fleck” sign is a radiographic finding indicative of significant labral injury in young patients with traumatic hip dislocations. In a new study, researchers from Nationwide Children’s Hospital show that treatment by surgical hip dislocation with open labral repair leads to excellent clinical outcomes in these patients. The results suggest that labral repair should be considered in the management of traumatic hip dislocation, especially when there is an associated positive “fleck” sign.

Traumatic, posterior hip dislocations and subluxations in pediatric patients are typically managed by closed reduction to achieve a concentric hip joint. Recently, a team from Nationwide Children’s reported that the presence of an acetabular “fleck” sign on post-reduction computed tomography (CT) or magnetic resonance imaging (MRI) signified serious injury usually warranting surgical fixation, despite concentric reduction.

“As we identified patients with post-reduction “fleck” signs, surgical exploration found nearly 100% had consistent osteochondral avulsions of the posterior labrum that required fixation,” says Kevin Klingele, MD, chief of the Department of Orthopedics at Nationwide Children’s and senior author of both papers.

In the new study, Dr. Klingele and colleagues evaluated the outcomes of open labral repair through surgical hip dislocation in patients with an acetabular “fleck” sign associated with a traumatic hip dislocation or subluxation. They performed a retrospective review of 29 pediatric patients treated at Nationwide Children’s between 2008 and 2022.

The researchers found that after at least two years of follow-up, all the patients had excellent clinical outcomes.

“We found no incidence of avascular necrosis down the road,” says Dr. Klingele, who is also an adjunct assistant professor of orthopedic surgery at The Ohio State University College of Medicine. “Patients returned to their sports and activities with minimal to no complication risk and good functional outcome scores.”

The findings suggest that traumatic hip dislocations and subluxations in young patients may be associated with more severe soft tissue injury than previously appreciated. Identification of the “fleck” sign on advanced imaging led to surgical repair of the osteochondrolabral injury that may otherwise have been overlooked.

“I think having a high index of suspicion and recognizing the “fleck” sign in these patients is key to ensuring they receive appropriate treatment and have the best long-term outcomes possible,” says Dr. Klingele.

“If there is a patient with either an impaction or suspected subluxation to their hip, advanced imaging in the form of CT or MRI, despite a congruent reduction, is important. And any child who has a traumatic hip dislocation that is reduced should have more advanced imaging than plain radiographs to identify this “fleck” sign in order to treat aggressively.”



Chen S, Tulchin-Francis K, Gaines D, Kadado A, Smith C, Klingele K. Acetabular “Fleck” Sign: Outcomes of Surgical Repair. Journal of Pediatric Orthopedics. 2024 May-Jun 01;44(5):e433-e438. doi: 10.1097/BPO.0000000000002657. Epub 2024 Mar 8.

Image credit: Nationwide Children’s

About the author

Mary a freelance science writer and blogger based in Boston. Her favorite topics include biology, psychology, neuroscience, ecology, and animal behavior. She has a BA in Biology-Psychology with a minor in English from Skidmore College in Saratoga Springs, NY, and a PhD from Brown University, where she researched bat echolocation and bullfrog chorusing.