Objective: Boerhaave’s syndrome is a spontaneous rupture of the oesophagus with a lack of diagnostic and treatment consistency in the literature. Therefore, we reviewed all published literature in order to design a treatment algorithm based on the literature. Study Design: A systematic literature review written in the English language since 1975. Results: We reviewed all known literature. Treatment of the Boerhaave syndrome was divided into three categories: conservative, endoscopic and surgical approach. The survival rate of all treatments was 75, 100 and 81%, respectively. Conclusion: Boerhaave’s syndrome should be treated endoscopically when diagnosed within 48 h and when there are no signs of sepsis. However, when a patient is diagnosed within 48 h and has a septic profile, thoracotomy with hemifundoplication and pleural/mediastinal drainage should be performed; and in case of intra-abdominal leakage, a laparotomy for local repair should be performed. When a patient is diagnosed after 48 h, conservative treatment should be followed and only when a patient gets a septic profile is surgical treatment indicated.

Four patients with injuries of the acetabular triradiate cartilage are presented. In three of them premature fusion of the cartilage occurred; two of these developed acetabular deformity and subluxation of the hip. In all patients the sacroiliacjoint also was injured; in two, thejoint was completely disrupted, leading to fusion and growth disturbance of the ilium. As injury ofthe triradiate cartilage is easily missed on the initial radiograph, it is advised that all patients with pelvic trauma should be followed clinically and radiographically foratleast one year. The acetabular triradiate cartilage is the composite growth-plate of the iliac, ischial and pubic bones. Premature closure of this physis is an infrequent complication

The treatment of choice of completely dislocated fractures of the intercondylar eminence is controversial. Recently, Zifko and Gaudernak [14] introduced a new classification in which they distinguish between two different types of intercondylar fractures: Type A: isolated avulsion of the anterior cruciate ligament Type B: fractures including the intercondylar eminence In order to assess whether this new classification could lead to a better selection of patients requiring open reduction, 19 children were reviewed 2-16 years after they had sustained a fracture of the intercondylar eminence. All patients with incompletely displaced fragments had an excellent or good ultimate result, independent of the kind of initial treatment received. Eleven patients sustained a complete displaced fracture. Of these, two had a poor result. Both had been treated conservatively for isolated avulsion of the anterior cruciate ligament. All conservatively treated type-B fractures had an excellent or good result. It is concluded that completely displaced type-A fractures require operative treatment by open reduction and fixation of the avulsed fragment.

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