Pediatric and Adolescent Fractures of the Acetabulum Treated With ORIF: What Are Their Functional Outcomes?

Southam, Brendan R.; Schumaier, Adam P.; Ramalingam, Wendy G; Avilucea, Frank R.; Denning, Jaime Rice; Whitlock, Patrick W.; Archdeacon, Michael T.

doi:10.1097/bot.0000000000002248

Cited by 3 publications

(3 citation statements)

References 27 publications

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“…In terms of treatment, both non-surgical and surgical management of pediatric acetabulum fractures using adult indications has resulted in acceptable clinical and radiographic outcomes. 37,43,44,[58][59][60]…”

Section: Discussionmentioning

confidence: 99%

Pediatric Pelvic and Acetabular Fractures: Diagnosis, Treatment, and Outcomes

Lopreiato¹,

Ramalingam²

2022

Journal of the Pediatric Orthopaedic Society of North America

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Pediatric orthopaedic surgeons routinely care for patients who sustain trauma due to unintentional injuries, including transportation-related injuries. While pelvic ring and acetabulum fractures are uncommon in this patient population, these injuries require thorough evaluation and individualized treatment to reduce associated morbidity and mortality. Trauma patients with pelvic fractures often have concomitant injuries to other organ systems, and their initial evaluation and management must begin with stabilization and evaluation for central nervous system and visceral injuries. A thorough orthopaedic evaluation is necessary to identify other extremity fractures and to determine the optimal treatment. Diagnosis and treatment of pediatric pelvic fractures is challenging due to the unique anatomy of the growing pelvis and varying injury patterns throughout childhood and adolescence. Radiographs and computed tomography can aid in appropriately classifying these fractures and aid in surgical planning. Fracture stability and deformity determine the need for surgical stabilization. Most pediatric pelvic fractures can be treated nonoperatively. For those that require surgical treatment, anterior and posterior pelvic fixation can be safely performed with appropriate planning and knowledge of the skeletally immature pelvis. Satisfactory outcomes can be obtained with correction of residual deformity or pelvic asymmetry less than 1 cm. The management of pediatric acetabulum fractures is similarly unique as treatment considerations include injury to the triradiate cartilage in addition to articular congruency and hip joint stability. The mechanism of injury in acetabulum fractures is frequently high energy trauma, however low energy mechanisms have been reported. MRI imaging is helpful to visualize the full extent of injury to the cartilaginous portions of the joint. Surgical intervention is reserved for patients with hip join instability, acetabulum incongruity >2mm, or failure to maintain a concentric reduction after attempt at closed management. Although acetabulum fractures can result in early osteoarthritis and disturbances in acetabular development, favorable results are seen with both operative and nonoperative management.

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Section: Discussionmentioning

confidence: 99%

Pediatric Pelvic and Acetabular Fractures: Diagnosis, Treatment, and Outcomes

Lopreiato¹,

Ramalingam²

2022

Journal of the Pediatric Orthopaedic Society of North America

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“…In adolescent patients with growth remaining, the principles of acetabular fixation involve anatomical reduction and insertion of screws [7 ▪ ] or contoured plates, with hardware typically removed [4,27] following healing in order to minimize growth disturbance. Skeletally mature patients can be treated as adults with acceptable clinical and radiographic outcomes [8,37]. In rare cases, total hip arthroplasty has been employed for adolescents with an unsalvageable joint [7 ▪ ].…”

Section: Definitive Managementmentioning

confidence: 99%

Traumatic injuries of the immature hip and pelvis

Moore,

Gnap,

Monsell

2023

Current Opinion in Pediatrics

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Purpose of review The pelvis and hip account for 0.3--4% of fractures of the immature skeleton, and generally result from high energy trauma. These fractures range in severity from apophyseal avulsions to complete disruptions of the pelvic ring. The purpose of this article is to review the presentation, diagnosis, treatment and complications of these injuries in order to inform clinicians involved in their management. There is a lack of evidence-based management protocols for fractures of the immature pelvis largely due to their rarity and lack of robust scientific literature on the topic. Recent findings Computed tomography/MRI is essential as up to 30% of pelvis and 70% of acetabular fractures are not identified on initial radiographs. A sub-optimal outcome is common in unstable fractures treated conservatively and adequate reduction and surgical stabilization is often required to avoid long-term morbidity. Summary A coordinated approach involves resuscitation and temporary stabilization with planned definitive fixation. It is generally accepted that these injures should be managed in paediatric trauma centres. Whilst injuries vary in pattern and severity, we present an overview that considers the evaluation and treatment of the paediatric patient with pelvic and hip fractures to ensure that these injuries are identified promptly and treated by surgeons familiar with contemporary management algorithms.

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“…Southam et al reported on pediatric and adolescent acetabular fractures treated with open reduction and internal fixation. Eighteen (86%) of 21 patients had a favorable functional outcome, although 2 patients with a delayed reduction (>6 hours) of a fracture-dislocation developed osteonecrosis 63 . Griffith et al reviewed patients with sickle cell disease who had a mean age of 14 years and were undergoing core decompression with a bone marrow aspirate concentrate injection for femoral head osteonecrosis.…”

Section: Hip Preservationmentioning

confidence: 99%