Pediatric and Adolescent Fractures of the Acetabulum treated with ORIF: What are their Functional Outcomes?

Objectives To evaluate the functional outcomes of pediatric and adolescent patients ( 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 following 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 to population norms. The modified Merle d'Aubigne clinical hip score, Matta radiologic outcome and post-operative complications were also documented. Results Functional outcome data was available at a mean of 5 years 2 months. Mean SF-36 scores were 44.8 and 50.1 for the physical component score (PCS) and mental component scores (MCS) respectively, which did not differ significantly from US population norms (PCS mean: 50, p=0.061; MCS 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 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 favorable functional outcome with the exception of the SMFA Functional Index which was significantly less than population norms. While 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 III. See Instructions for Authors for a complete description of levels of evidence.