Management of an open acetabular fracture in a skeletally immature patient

Abstract

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.

Fig. (1)

Axial CT scan at day of injury revealing a left anterior column acetabular fracture which involves the tri-radiate cartilage.

Fig. (2)

The postoperative pelvic X-ray in a spica cast shows anatomic reduction of the left acetabular fracture.

Fig. (3)

Follow-up X-rays taken at 8 weeks (A) and 4 months (B) demonstrate a healed left acetabular fracture in anatomic position and indicate an early physeal closure with callus formation about the tri-radiate cartilage (arrow in panel B).

Fig. (4)

A CT scan obtained after hardware removal at 10 months demonstrates the healed fracture in anatomic position and confirms the suspected early physeal closure of the left acetabulum (arrow in the coronal view).

Fig. (5)

Pelvic X-ray at 4 months (A) and one year (B) after physeal bar resection shows a wide open spacing without signs of recurrent premature closure of the tri-radiate cartilage (arrows).