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Management of an open acetabular fracture in a skeletally immature patient
Sarah Y Clutter1, Steven J Morgan, Mark Erickson
1Department of Orthopedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204, USA.
Insights
Open, displaced pediatric acetabular fractures require prompt surgical intervention. Physeal bar resection may be necessary to ensure normal hip function after healing, especially when the tri-radiate cartilage is involved.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Pediatric Acetabular Fractures
Background:
- Open acetabular fractures in children are rare but severe injuries.
- Limited literature exists on managing these complex pediatric fractures.
Purpose of the Study:
- To present a case study on the management of an open pediatric acetabular fracture.
- To highlight effective treatment strategies and outcomes.
Main Methods:
- Case report of a 3-year-old girl with a grade IIIA open acetabular fracture.
- Surgical treatment involved ilioinguinal approach, debridement, anatomical reduction, and screw fixation.
- Post-operative care included casting and non-weight bearing, followed by physeal bar resection.
Main Results:
- The acetabular fracture healed anatomically within 8 weeks without complications.
- Physeal bar resection at one year prevented premature tri-radiate cartilage closure.
- Two-year follow-up showed pain-free ambulation and full range of motion in the left hip.
Conclusions:
- Surgical management is the preferred treatment for open, displaced pediatric acetabular fractures.
- Physeal bar resection is a crucial consideration for fractures involving the tri-radiate cartilage to ensure long-term hip function.
Background:
Open acetabular fractures in children are rare, but potentially devastating injuries. Secondary to the low incidence, there is an apparent lack of reports on appropriate management strategies for open pediatric acetabular fractures in the literature.
Methods:
Description of a case study.
Results:
A 3 years and ten months-old girl was ejected as a passenger from an all terrain vehicle. She sustained a displaced, grade IIIA open left anterior column acetabular fracture. The injury was treated by extending the open wound to a formal first window of the ilioinguinal approach. After surgical debridement, the anterior column was reduced anatomically and fixed by two lag screws which avoided the tri-radiate cartilage. A vaginal laceration was debrided and repaired. The patient was treated in a spica cast without weight bearing on the left lower extremity for 8 weeks. No perioperative complications occurred. The acetabular fracture healed in an anatomic position within 8 weeks. To avoid premature closure of the tri-radiate cartilage, the patient underwent a physeal bar resection at one year after injury. At two-year follow up, she was walking and running without pain and had a free range of motion of her left hip.
Conclusions:
Operative management should represent the therapy of choice for open, displaced pediatric acetabular fractures. After fracture healing, a scheduled physeal bar resection may be required for injuries which involve the tri-radiate cartilage.
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Assessment:
1. Clinical Evaluation:
History: