Pelvic And Acetabular Trauma

Pelvic and Acetabular Trauma

Many of the same considerations as in adult pelvic and acetabular trauma – associated head, chest, abdominal visceral injuries and vascular trauma are common.
– diagnosis can be made difficult because of cartilage in the region
– growth disturbances can lead to biomechanical alterations later in life
– the major consequences of pelvic fracture are hemorrhage, shock, death; bladder/urethral injury; neurologic injury (lumbosacral plexus); and infection following open fractures

Pelvic Fracture Classification – translated from adult (Tile)
– A: avulsion, not involving the ring
– B: horizontally unstable, vertically stable
– C: horizontally and vertically unstable
– don’t forget to check stability on the physical examination! Don’t rely completely on the x-rays!

Acetabular Fracture Classification – also, translated from adult (Letournel)
– posterior wall
– posterior wall and posterior column
– posterior column
– posterior wall and transverse
– anterior wall
– T type fracture
– anterior column – anterior wall, posterior hemitransverse
– transverse
– bicolumnar

– Judet views are helpful
– if getting CT – get fine slice cuts to help with the small size (2.5 – 3.0 mm)
– consider hip arthrography in child under 8 in whom you suspect fracture/dislocation of proximal femur

Treatment

In general, these injuries are being treated more and more like adult injuries

– historically, acetabular trauma was treated non-operatively. Now, people are going after them if there is 2 mm incongruity or instability
– 3 cm anterior diastasis can be treated with ORIF or external fixator
– posterior fracture dislocations of the SI complex are being treated more commonly now with internal fixation
– bedrest is still good for undisplaced acetabular fractures or stable pelvic injuries

External Fixation
– biologic treatment for massive hemorrhage
– need slightly smaller Schanz pins – usually the 4.0 or 5.0 mm pins are too big. Can get 2.5 mm pins for infants or toddlers. Do a simple frame – one or two pins in each crest through 1 cm stab wounds, with two connecting rods. The pins should be introduced through a predrilled hole of slightly smaller diameter. The hole should just penetrate the superior iliac ring cortex, and the pin should be placed by hand chuck to minimize the chances of perforation. Smooth K-wires can be place on the inner and outer cortices of the iliac ring as directional guides. Adequate room should be allowed between the bars and the abdomen to allow the patient to sit up and to permit abdominal examination.