Acetabulum Fracture with Closed Triradiate
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Acetabulum fractures in pediatric patients are rare injuries usually occurring after closure of the triradiate cartilage. They occur almost exclusively following high energy trauma and thus a thorough primary and secondary survey is necessary to assess for associated injuries. Examination of the genitourinary system and neurovascular status is critical. Aggressive resuscitation and stabilization should occur during the hospitalization, and multiple services including general surgery, urology, and orthopedic surgery may be necessary for optimal management. Classification is best described using the Letournel Classification. The need for operative intervention increases after triradiate closure. Definitive surgical management should occur within the first week, once the patient has been adequately resuscitated, preoperative imaging and planning has been completed, and all personal and equipment is available. Blood products should be available during the procedure. Various patient position and surgical approaches are utilized depending on the fracture pattern and soft tissue status. Obtaining excellent fluoroscopic images is necessary during the procedure. Articular reduction is critical to obtaining successful outcomes. Malreduction and associated genitourinary and neurologic injuries are directly related to poor long-term outcomes.