Date: Thu, 19 Apr 2001 23:33:40 -0000
Subject: Pelvic Fracture - Age 14
From: Dr. Josep M. Muñoz Vives
A 14 yo boy suffered this pelvic fracture in a MVA, he was not wearing a seat belt and was found 10 meters away from the car.
He has an associated right humeral fracture, but no other cranio-toraco- abdominal lesion.
Regarding the sacroiliac dislocation associated to the transverse fracture of the acetabulum. What are the list opinions and warnings regarding treatment of these lesions in a 14 yo boy.
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All coments will be welcomed.
Dr. Josep M. Muñoz Vives
Orthopedic Dept.
Hospital Universitari Dr. Josep Trueta.
Girona
Catalunya, Spain
Date: Fri, 20 Apr 2001 08:03:39 -0700
From: Thomas A. DeCoster
14 year old male in Spain with a left acetabulum fracture (displaced, transverse, subtectal) and a pelvic ring disruption with left sacro-iliac joint disruption (probably).
I believe the left acetabulum fracture should definitely be reduced and fixed. The approach to the acetabulum, whether or not to internally fix the posterior pelvic ring injury, and the approach to the posterior pelvic ring are all debateable. Tom DeCoster
Date: Fri, 20 Apr 2001 11:22:01 -0700
From: John Ruth
I would perform open posterior reduction of the SI joint with probably 1 iliosacral screw for fixation (anatomic reduction is key for ultimate reduction of the acetabular fracture). I would then proceed with open reduction and plate fixation of the transverse acetabular fracture using a Kocher-Langenbeck approach (seems to be more displaced posteriorly than anteriorly). I have plated across the triradiate cartilage in this age patient in the past and it did not seem to produce any long term problems. Another option would be an ilioinguinal approach with open anterior reduction of the SI joint and percutaneous SI screw with anterior plate fixation of the acetabular fracture. Since it appears more displaced posteriorly this may be more difficult to reduce anatomically from the front.
Date: Fri, 20 Apr 2001 15:07:10 -0400
From: Charles Mehlman
Dr Munoz-Vives:
My answers to your four questions...
Other thoughts: there is a small (but real) chance of utilizing internal fixation that avoids crossing the triradiate cartilage - BUT, in the end I would choose what stabilizes the acetabular fracture best (like a long recon plate) as the liklihood of creating significant acetabulum-head mismatch during this boy's last two years of growth (estimated) is minimal. Besides, he has much bigger worries (such as avascular necrosis of his femoral head).
Below are several relatively recent references on this topic...
Hope this helps.
Date: Fri, 20 Apr 2001 19:46:31 -0500
From: Kyle Dickson, MD
Dear josep,
the si joint needs to be anatomic if you hope to get the acetabulum anatomic. I would likely orif the posterior si with 2 iliosacral screws then do a posterior approach to the acetabulum with recon plates. I'll be lecturing to the scandinavian orthopedic society Sunday in Malaga on this topic so I'll be close to you.
kyle
Date: Sat, 21 Apr 2001 09:23:39 -0700
From: Victor de Ridder
Dr Munoz-Vives, dear colleague,
I totally agree with Charkes Mehlmans approach, we would indeed fix both fractures, but take the fixation materials out in 6 months time. In future to be published series of these combinations, rare but we have 4 patients with this combination but also other combinations, fixation do best.
Greetings,
Victor de Ridder ( Westend Hospital, The Hague, Holland)
