Related Experiment Video
Updated: Jun 10, 2025
Method and Instrumented Fixture for Femoral Fracture Testing in a Sideways Fall-on-the-Hip Position
Published on: August 17, 2017
Practice Patterns Vary Widely in the Care of Pediatric and Adolescent Pelvic and Acetabular Fractures: A CORTICES
Brennan Roper1, S Rose Purtell2, Sayan De2
1Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, TX.
Insights
Management of pediatric pelvic and acetabular fractures varies significantly, with trauma fellowship-trained surgeons often involved in care. Patient age and fracture type influence treatment decisions and transfer patterns at pediatric trauma centers.
Area of Science:
- Orthopaedic Surgery
- Pediatric Trauma Care
- Skeletal Injury Management
Background:
- Pediatric pelvic and acetabular fractures are rare yet severe injuries.
- Significant variation exists in their management across the United States.
- Understanding treatment trends and surgeon involvement is crucial.
Purpose of the Study:
- To analyze treatment decision-making for pediatric pelvic and acetabular fractures.
- To determine the involvement of adult trauma fellowship-trained surgeons in pediatric cases.
- To investigate pre- and postoperative patient transfer patterns.
Main Methods:
- Survey of pediatric orthopaedic surgeons at 20 pediatric trauma centers (PTCs).
- Inclusion of five clinical scenarios varying by fracture type, age, and sex.
- Descriptive statistical analysis of survey responses.
Main Results:
- 18 institutions responded (90% response rate).
- Surgeons cited patient age, fracture characteristics, displacement, and surgical need as key management factors.
- Older patients were more likely to be transferred, and trauma-trained surgeons frequently managed cases, even without transfers.
Conclusions:
- Substantial variation exists in managing pediatric and adolescent pelvic and acetabular fractures.
- Low fracture volumes are common even at tertiary PTCs.
- Age and injury pattern significantly influence management variation and patient transfers.
Introduction:
Pediatric pelvic and acetabular fractures are rare but potentially devastating injuries and significant management variation exists across the United States. This study sought to elucidate treatment decision-making trends, involvement of adult trauma fellowship-trained surgeons in pediatric care, and pre- and postoperative transfer patterns.
Methods:
Pediatric orthopaedic surgeons who serve as trauma liaisons at 20 PTCs were surveyed regarding training, practice volume, and factors contributing to institutional management of pelvic and acetabular injuries. Five clinical scenarios of pelvic ring and acetabular fractures that varied by injury pattern, age, and sex were presented. Descriptive statistics were used to summarize the results.
Results:
Eighteen institutions responded to the survey (90% response rate, 16 Level, 1 PTC). All surgeons were pediatric fellowship-trained (77.7% in practice >5 y). The four most common factors affecting whether surgeons independently managed both pelvic ring and acetabular fractures were patient age, fracture characteristics, displacement and need for surgery. The majority reported managing <10 acetabular (72.2%) but >10 pelvic ring (77.8%) injuries per year. In the clinical scenarios, patients <10 were more likely to have treatment decisions made by a pediatric orthopaedic surgeon. Older patients were more likely to be transferred to another institution for surgery but were often transferred back to the PTC postoperatively. In all clinical scenarios other than posterior hip dislocation, a trauma fellowship-trained surgeon was more likely to be the operative surgeon, even when the patient was not transferred.
Conclusions:
There is substantial variation in the management of pediatric and adolescent pelvic and acetabular fractures. Even at tertiary care PTCs, volumes are low, and trauma fellowship-trained surgeons are often involved in decision-making and operative management. Age and injury pattern seem to play a large role in variation, and patient transfers between facilities are common.
Level Of Evidence:
V.
More Related Videos
09:51The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
08:15Three-Dimensional Preoperative Virtual Planning in Derotational Proximal Femoral Osteotomy
Published on: February 17, 2023
Related Concept Videos
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
01:16Bones of the Lower Limb: Femur and Patella
01:18Assessment of the Abdomen II: Percussion
Percussion
Percussion is an essential...