Main Article Content
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.