Background: Acetabular fractures in children are extremely rare, accounting for approximately 1%–4.6% of all pediatric fractures. Due to their rarity, literature on these injuries is limited, with only a few reported cases. The primary objective of this study was to present a series of uncommon pediatric injuries, outline our management approach, and demonstrate that even patients undergoing delayed surgical intervention can achieve favorable clinical outcomes.
Materials and Methods: This retrospective study reviewed records of skeletally immature patients with traumatic acetabular fractures treated at our institution. Patients were surgically treated with open reduction and internal fixation through lateral rectus abdominis approach; follow-ups included radiological assessment of bone union and internal fixation integrity. Postoperative reduction was evaluated using Matta's criteria, while functional outcomes were measured via the Modified Merle d'Aubigné and Postel Method (pain, gait, mobility) and the Harris Hip Score (HHS). Complications were documented throughout follow-up.
Results: Between January 2019 and January 2025, 14 pediatric patients with acetabular fractures (five males, nine females; mean age 11.42 ± 2.24 years) were treated and followed for an average of 33.71 ± 14.41 months. Injuries resulted from falls (57.14%), car accidents (28.57%), and motorcycle/bicycle accidents (7.14% each). According to Judet and Letournel classification, fractures included double-column (57.14%), transverse (35.72%), and anterior with posterior hemi-transverse (7.14%). All underwent surgery, achieving bone union. The mean Harris Hip Score was 90.35 ± 5.58, with 71.42% rated excellent, 21.42% good, and 7.14% fair. The mean Merle d'Aubigné score was 17.21 ± 1.12. Mild hip pain occurred in three patients, with no other complications.
Conclusion: Pediatric acetabular fractures, typically caused by high-energy trauma, require treatment focused on optimal outcomes and anatomical reduction, even in delayed cases. This study shows that, in specialized centers, experienced surgical teams can achieve successful reduction and satisfactory results despite delayed intervention.
| [1] |
Y. Liu, Y. Yang, and L. Zhou, “Pediatric Complex Acetabular Fracture: A Case Report,” Asian Journal of Surgery 46, no. 10 (2023): 4453–4454.
|
| [2] |
R. Tomaszewski, J. Klet, K. Pethe, and A. Zachurzok, “Treatment of Acetabular Fractures in Paediatric Patients,” Ortopedia, Traumatologia, Rehabilitacja 23, no. 5 (2021): 341–348.
|
| [3] |
A. Braunbeck and I. Marzi, “Polytrauma in Young Children,” in The Poly-Traumatized Patient With Fractures: A Multi-Disciplinary Approach, ed. H.-C. Pape, R. Sanders, and J. J. Borrelli (Springer Berlin Heidelberg, 2016), 231–243.
|
| [4] |
C. J. DeFrancesco and W. N. Sankar, “Traumatic Pelvic Fractures in Children and Adolescents,” Seminars in Pediatric Surgery 26, no. 1 (2017): 27–35.
|
| [5] |
C. G. Kruppa, D. L. Sietsema, J. D. Khoriaty, M. Dudda, T. A. Schildhauer, and C. B. Jones, “Acetabular Fractures in Children and Adolescents: Comparison of Isolated Acetabular Fractures and Acetabular Fractures Associated With Pelvic Ring Injuries,” Journal of Orthopaedic Trauma 32, no. 2 (2018): e39–e45.
|
| [6] |
V. A. de Ridr and S. A. Olson, “Operative Treatment of Pediatric Pelvic and Acetabulum Fractures,” Journal of Orthopaedic Trauma 33, no. Suppl 8 (2019): S33–S37.
|
| [7] |
W. Schlickewei, B. Götze, and R. Salm, “Beckenverletzungen Beim Kind—Besondere Aspekte Beim Polytrauma,” in Das Kindliche Polytrauma, ed. J. M. Rueger, W. Schlickewei, J. Engert, and D. W. Sommerfeldt (Steinkopff, 2004), 83–97.
|
| [8] |
M. Spina, V. Luppi, J. Chiappi, F. Bagnis, and G. Rocca, “Triradiate Cartilage Fracture of the Acetabulum Treated Surgically,” Acta Bio Medica: Atenei Parmensis 90, no. 1 (2019): 116–121.
|
| [9] |
J. H. Harris, K. J. Coupe, J. S. Lee, and T. Trotscher, “Acetabular Fractures Revisited: Part 2, a New CT-Based Classification,” AJR American Journal of Roentgenology 182, no. 6 (2004): 1367–1375.
|
| [10] |
R. T. Trousdale and R. Ganz, “Posttraumatic Acetabular Dysplasia,” Clinical Orthopaedics and Related Research 305 (1994): 124–132.
|
| [11] |
E. Letournel, “Acetabulum Fractures: Classification and Management,” Clinical Orthopaedics and Related Research 151 (1980): 81–106.
|
| [12] |
A. B. Witte, K. Van Arendonk, C. Bergner, et al., “Venous Thromboembolism Prophylaxis in High-Risk Pediatric Trauma Patients,” JAMA Surgery 159, no. 10 (2024): 1149–1156.
|
| [13] |
J. M. Hendrix and E. H. Garmon, “American Society of Anesthesiologists Physical Status Classification System,” in StatPearls (StatPearls Publishing, 2025).
|
| [14] |
A. Alhammoud, I. Moghamis, H. Abdelrahman, et al., “Clinical Characteristics, Injury Pattern and Management of Pediatric Pelvic Fracture: An Observational Retrospective Study From a Level I Trauma Center,” BMC Musculoskeletal Disorders 22, no. 1 (2021): 626.
|
| [15] |
B. Roper, S. R. Purtell, S. De, et al., “Practice Patterns Vary Widely in the Care of Pediatric and Adolescent Pelvic and Acetabular Fractures: A CORTICES Survey,” Journal of Pediatric Orthopedics 45, no. 3 (2025): e229–e235.
|
| [16] |
J. M. Guillaume, S. Pesenti, J. L. Jouve, and F. Launay, “Pelvic Fractures in Children (Pelvic Ring and Acetabulum),” Orthopaedics & Traumatology, Surgery & Research 106, no. 1s (2020): S125–s133.
|
| [17] |
L. Nieto-Lucio, A. Camarillo-Martínez, S. Camacho-González, S. U. Ceja-Picazo, and J. M. Pérez-Atanasio, “Closed Reduction of the Sacroiliac Joint and Acetabular Reconstruction in a Pediatric Patient With a Torode/Zieg IVd Unstable Pelvic Fracture. Case Report,” Acta Ortopédica Mexicana 29, no. 6 (2015): 323–327.
|
| [18] |
T. Hearty, V. T. Swaroop, P. Gourineni, and L. Robinson, “Standard Radiographs and Computed Tomographic Scan Underestimating Pediatric Acetabular Fracture After Traumatic Hip Dislocation: Report of 2 Cases,” Journal of Orthopaedic Trauma 25, no. 7 (2011): e68–e73.
|
| [19] |
M. M. Khair, C. S. Smith, and D. L. Helfet, “Pediatric Hip Dislocation With Posterior Wall Acetabular Fracture: A Case Report,” HSS Journal: The Musculoskeletal Journal of Hospital for Special Surgery 10, no. 3 (2014): 280–285.
|
| [20] |
J. M. Matta, “Operative Treatment of Acetabular Fractures Through the Ilioinguinal Approach: A 10-Year Perspective,” Journal of Orthopaedic Trauma 20, no. 1 Suppl (2006): S20–S29.
|
| [21] |
N. Chotai, S. Alazzawi, S. S. Zehra, and M. Barry, “Paediatric Pelvic Fractures: A Review of 2 Cohorts Over 22 Years,” Injury 49, no. 3 (2018): 613–617.
|
| [22] |
M. Heeg, V. A. de Ridr, P. Tornetta, S. de Lange, and H. J. Klasen, “Acetabular Fractures in Children and Adolescents,” Clinical Orthopaedics and Related Research 376 (2000): 80–86.
|
| [23] |
J. S. Daurka, A. K. Malik, D. A. Robin, and J. D. Witt, “The Results of Uncemented Total Hip Replacement in Children With Juvenile Idiopathic Arthritis at Ten Years,” Journal of Bone and Joint Surgery British Volume 94, no. 12 (2012): 1618–1624.
|
| [24] |
R. W. Bucholz, M. Ezaki, and J. A. Ogden, “Injury to the Acetabular Triradiate Physeal Cartilage,” Journal of Bone & Joint Surgery 64, no. 4 (1982): 600–609.
|
| [25] |
N. Lopreiato and W. G. Ramalingam, “Pediatric Pelvic and Acetabular Fractures: Diagnosis, Treatment, and Outcomes,” Journal of the Pediatric Orthopaedic Society of North America 4, no. 2 (2022): 466.
|
| [26] |
L. F. Amorosa, P. Kloen, and D. L. Helfet, “High-Energy Pediatric Pelvic and Acetabular Fractures,” Orthopedic Clinics of North America 45, no. 4 (2014): 483–500.
|
RIGHTS & PERMISSIONS
2026 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
PDF
(906KB)
