Stabilization Surgery for Hip Fractures Improves Outcomes for Some Pediatric Patients

Published March 2022 | Journal of Orthopedic Trauma

Surgical intervention could improve hip joint function for some pediatric and adolescent patients with hipbone socket (acetabulum) fractures, according to research conducted by Patrick Whitlock, MD, PhD, and colleagues.

These findings were based on the self-reported functional outcomes of 21 patients under age 18—one of the largest studies of its kind to date. Researchers found that open reduction internal fixation (ORIF) surgery could benefit patients who experience the same factors that support surgery in adults. They must have a fracture that is displaced by at least 2 mm in the weight-bearing portion of the hip, as well as hip instability.

“We strongly advocate for operative management of pediatric acetabulum fractures when adult displacement and instability criteria are present,” Whitlock says. “We recommend urgent reduction of all pediatric and adolescent acetabulum fracture dislocations once diagnosed, given the high risks of poor outcomes associated with delayed reduction.”

Few guidelines exist for treating this type of pediatric fracture. Most have been left to heal on their own. However, that can lead to complications. In fact, patients who have dislocated fractures for more than six hours have a 20-times higher risk of developing avascular necrosis than patients who receive prompt surgical intervention, Whitlock says.

The team used functional and health surveys to evaluate outcomes for pediatric patients who underwent ORIF surgery. Results included 86% reporting normal physical and mental component scores post-operatively, as well as normal bother scores. However, function scores were worse: 31.9 compared to the 12.7 population average, largely for patients who had delayed surgery.

“It’s possible that younger, more active patients expect to have a higher level of function than an older adult population,” he says. “That could account for the significant difference in scores.”