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Pediatric and Adolescent Fractures of the Acetabulum Treated With ORIF: What Are Their Functional Outcomes?
Brendan R Southam1, Adam Schumaier1, Wendy Ramalingam2
1Department of Orthopaedic Surgery, University of Cincinnati Academic Health Center, Cincinnati, OH.
Insights
Pediatric acetabulum fractures treated with open reduction internal fixation (ORIF) showed generally favorable outcomes, though functional indices were lower than population norms. Early reduction is crucial for optimal results in these complex fractures.
Area of Science:
- Orthopedic surgery
- Pediatric traumatology
- Musculoskeletal outcomes research
Background:
- Acetabulum fractures in pediatric and adolescent patients are rare but can lead to significant long-term morbidity.
- Optimal treatment strategies for these injuries remain debated, particularly regarding the role of operative intervention.
Purpose of the Study:
- To evaluate the functional outcomes of pediatric and adolescent patients (<18 years) treated with open reduction internal fixation (ORIF) for acetabulum fractures.
- To compare functional outcomes with population norms and identify factors influencing results.
Main Methods:
- Retrospective cohort study at a Level 1 trauma center.
- Included 34 pediatric/adolescent patients undergoing acetabulum fracture ORIF (2001-2018).
- Functional outcomes assessed using SF-36, Short Musculoskeletal Functional Assessment (SMFA), and modified Merle d'Aubigné score; compared to population norms.
Main Results:
- 21 patients had adequate follow-up (>6 months) at a mean of 5.2 years.
- SF-36 scores (physical and mental) were comparable to US population norms.
- SMFA Bother Index was not significantly different, but the SMFA Function Index was significantly worse than population norms (P=0.001).
- Two patients with delayed reduction (>6 hours) developed avascular necrosis and post-traumatic osteoarthritis, resulting in poor outcomes.
Conclusions:
- 86% of patients achieved favorable functional outcomes, excluding the SMFA Function Index.
- Operative management is advocated for pediatric/adolescent acetabulum fractures meeting adult displacement and instability criteria.
- Long-term follow-up is necessary to fully understand outcomes; early reduction is critical.
Objectives:
To evaluate the functional outcomes of pediatric and adolescent patients (<18 year old) who sustained acetabulum fractures that were treated with open reduction internal fixation (ORIF).
Design:
Retrospective cohort.
Setting:
Level 1 trauma center.
Patients:
Thirty-four pediatric and adolescent patients underwent acetabulum fracture ORIF between 2001 and 2018. Of the operatively treated patients, 21 patients had sufficient follow-up (>6 months), one died after fixation secondary to other traumatic injuries, and 12 patients were lost to follow-up.
Intervention:
Acetabulum fracture ORIF.
Main Outcome Measurement:
The SF-36 Health Survey and Short Musculoskeletal Functional Assessment (SMFA) were compared with population norms. The modified Merle d'Aubigné clinical hip score, Matta radiologic outcome, and postoperative complications were also documented.
Results:
Functional outcome data were available at a mean of 5 years 2 months. Mean SF-36 scores were 44.8 and 50.1 for the physical component score and mental component scores, respectively, which did not differ significantly from US population norms (physical component score mean: 50, P = 0.061 and mental component score mean: 50, P = 0.973). Furthermore, the mean SMFA Bother Index score was 18.6, which is not significantly different from the population norm mean of 13.8 (P = 0.268). However, the function index mean was 31.9, which was significantly worse than the population norm mean of 12.7 (P = 0.001). Two patients with a delayed reduction (>6 hours) of an acetabulum fracture dislocation had poor outcomes related to the development of avascular necrosis and post-traumatic osteoarthritis.
Conclusion:
In this small cohort, 86% (18/21) of these patients had a favorable functional outcome with the exception of the SMFA Functional Index that was significantly less than population norms. Although long-term follow-up is needed, we advocate for operative management of pediatric and adolescent acetabulum fractures when adult displacement and instability criteria are present.
Level Of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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