Russian Journal of Pediatric SurgeryRussian Journal of Pediatric SurgeryДетская хирургия1560-95102412-0677Eco-Vector83410.17816/ps834TJWDPUReviewsОБЗОРЫReview ArticleTreatment of acetabular fractures in pediatric patientsВопросы диагностики и лечения переломов вертлужной впадины у детейhttps://orcid.org/0000-0002-3426-0682UseinovAndrey V.УсеиновАндрей Валентинович
Russian Federation
med.useinov@gmail.comhttps://orcid.org/0000-0003-3686-3708KeshishyanRazmik А.КешишянРазмик Арамович
Russian Federation

MD, Dr. Sci. (Medicine)

д-р мед. наук

razmik_k@mail.ruhttps://orcid.org/0000-0003-4383-27077312-0252PetrovMikhail А.ПетровМихаил Анатольевич
Russian Federation

MD, Cand. Sci. (Medicine)

канд. мед. наук

m.petrov@me.comhttps://orcid.org/0000-0003-1179-921XManzhosPetr I.МанжосПетр Иванович
Russian Federation

MD, Cand. Sci. (Medicine)

канд. мед. наук

manzhos@mail.ruhttps://orcid.org/0009-0009-0061-8605MansurovaSaodat U.МансуроваСаодат Умедовна
Russian Federation
saodat.2002@mail.ruSechenov First Moscow State Medical UniversityПервый Московский государственный медицинский университет им. И.М. СеченоваPatrice Lumumba Peoples’ Friendship University of RussiaРоссийский университет дружбы народов им. Патриса ЛумумбыRussian Medical Academy of Continuous Professional EducationРоссийская медицинская академия непрерывного профессионального образованияVoino-Yasenetsky Scientific and Practical Center for Specialized Medical Care for ChildrenНаучно-практический центр специализированной медицинской помощи детям им. В.Ф. Войно-ЯсенецкогоIlyinskaya HospitalИльинская больница22042025050620252921041092609202424032025Copyright ©; 2025, Useinov A.V., Keshishyan R.А., Petrov M.А., Manzhos P.I., Mansurova S.U.Copyright ©; 2025, Усеинов А.В., Кешишян Р.А., Петров М.А., Манжос П.И., Мансурова С.У.2025Useinov A.V., Keshishyan R.А., Petrov M.А., Manzhos P.I., Mansurova S.U.Усеинов А.В., Кешишян Р.А., Петров М.А., Манжос П.И., Мансурова С.У.https://eco-vector.com/for_authors.php#07https://jps-nmp.ru/jour/article/view/834

The present review of current scientific and practical literature is devoted to the analysis of modern diagnostics and management of acetabulum fractures in children. Systematized research and clinical findings have proven that computed tomography remains the “gold standard” for diagnostics (accuracy up to 80%) of acetabulum fractures in children. However, it is not available in some regional hospitals what increases the risk of intraoperative errors committed by an orthopedic traumatologist and a pediatric surgeon. Conservative management (plaster casts, skeletal traction) is acceptable in undisplaced fractures, but it is associated with a high risk of complications: thrombosis, deformities (including the extremity discrepancy in the growing organism), osteoarthritis, etc. Surgical intervention is indicated in dislocated fragments of more than 2 mm, joint instability or damage to the posterior wall of the cavity. The optimal access depends on the fracture location and surgeon’s experience. The key success factors for treating acetabulum fractures in children are: reposition of the dislocation within the first 6 hours, compliance with aseptic rules, and early rehabilitation. The authors emphasize the need to equip regional and district hospitals with computer/magnetic resonance devices, to develop unified protocols and to train surgeons in minimally invasive techniques. The results obtained in the study are important for improving pediatric traumatology.

Представленный обзор актуальной научно-практической литературы посвящён анализу современных методов диагностики и лечения переломов вертлужной впадины у детей. На основе систематизации данных научно-практических исследований доказано, что компьютерная томография остаётся «золотым стандартом» диагностики (точность до 80%) переломов вертлужной впадины у детей, однако её недоступность в региональных стационарах повышает риск интраоперационных ошибок, совершаемых травматологом-ортопедом, детским хирургом. Консервативная терапия (гипсовые повязки, скелетное вытяжение) допустима при переломах без смещения, но сопряжена с высоким риском осложнений: тромбозов, деформаций (в т.ч. укорочения конечности по мере роста организма), остеоартрита и т.д. Хирургическое вмешательство показано при смещении отломков более 2 мм, нестабильности сустава или повреждении задней стенки впадины. Оптимальный доступ зависит от локализации перелома и опыта оперирующего специалиста. Ключевые факторы успеха лечения переломов вертлужной впадины у детей: вправление вывиха в первые 6 ч, соблюдение правил асептики и ранняя реабилитация. Подчёркивается необходимость внедрения компьютерной/магнитно-резонансной томографии в региональные и районные больницы, разработки унифицированных протоколов и обучения хирургов малоинвазивным методикам. Результаты исследования актуальны для совершенствования педиатрической травматологии.

fractureacetabulumchildrensurgical accessпереломвертлужная впадинадетихирургический доступGänsslen A, Heidari N, Weinberg AM. Fractures of the pelvis in children: a review of the literature. Eur J Orthop Surg Traumatol. 2013;23(8):847–861. doi: 10.1007/s00590-012-1102-0Chotai N, Alazzawi S, Zehra SS, Barry M. Paediatric pelvic fractures: A review of 2 cohorts over 22 years. Injury. 2018;49(3):613–617. doi: 10.1016/j.injury.2018.02.005Shlykov IL, Kuznetsova NL. Features of treatment of pelvic bone fractures in adolescents. Ural Med J. 2010;69(4):74–79. EDN: MVLNMFSilber JS, Flynn JM. Changing patterns of pediatric pelvic fractures with skeletal maturation: implications for classification and management. J Pediatr Orthop. 2002;22(1):22–26.Bucholz RW, Ezaki M, Ogden JA. Injury to the acetabular triradiate physeal cartilage. J Bone Joint Surg Am. 1982;64(4):600–609.Grisoni N, Connor S, Marsh E, et al. Pelvic fractures in a pediatric level I trauma center. J Orthop Trauma. 2002;16(7):458–463. doi: 10.1097/00005131-200208000-00003Gänsslen A, Hildebrand F, Heidari N, Weinberg AM. Acetabular fractures in children: a review of the literature. Acta Chir Orthop Traumatol Cech. 2013;80(1):10–14. doi: 10.55095/achot2013/002Lopreiato N, Ramalingam WG. Pediatric Pelvic and Acetabular Fractures: Diagnosis, Treatment, and Outcomes. Journal of the Pediatric Orthopaedic Society of North America. 2022;4(2):466. doi: 10.55275/JPOSNA-2022-0041Matta JM, Cockin J, Letournel E, et al. Azetabulum. In: Manual der Osteosynthese. Berlin, Heidelberg: Springer; 1992. doi: 10.1007/978-3-642-87407-9_10Letournel E, Judet R. Fractures of the Acetabulum. Springer-Verlag Berlin Heidelberg, 1993. 733 p.Shaath MK, Ippolito JA, Adams MR, et al. The Role of the Computed Tomographic Scan in the Diagnosis of Acetabular Fracture in the Immature Pelvis. J Orthop Trauma. 2019;33(Suppl. 2): S32–S36. doi: 10.1097/BOT.0000000000001414Tazeabadi SA, Noroozi SG, Salehzadeh M, et al. Evaluation of Judet view radiographs accuracy in classification of acetabular fractures compared with three-dimensional computerized tomographic scan: a retrospective study. BMC Musculoskelet Disord. 2020;21(1):405. EDN: MICETP doi: 10.1186/s12891-020-03441-9Judet R, Judet J, Letournel E. Fractures of the acetabulum: Classification and surgical approaches for open reduction: Preliminary report. J Bone Joint Surg Am. 1964;46: 1615–1646Watts HG. Fractures of the pelvis in children. Orthop Clin North Am. 1976;7(3):615–624Cherkes-Zadeh DI. Pelvic injuries: hands. Shaposhnikov YuG, editor. Moscow: Medicine, 1997. 249 p.Kazantsev AB, Ter-Grigoryan AA, Putyatin SM, Makarova SI. Operative accesses for pelvic bone fractures. Vestn. experimental and clinical surgery. 2011;2(4):305–313. EDN: MYGYMIBondarenko AV, Talashkevich MN, Kruglykhin IV, Plotnikov IA. Fractures of the posterior wall of the acetabulum. Polytrauma. 2022;(1):28–37. EDN: SMFMIXMagala M, Popelka V, Bozik M, et al. Conservative Treatment of Acetabular Fractures: Epidemiology and Medium-term Clinical and Radiological Results. ACHOT. 2015;82(1):51–60. doi: 10.55095/achot2015/007Chegurov O, Menshchikov I. Treatment of acetabulum injuries and their consequences (literature review). The genius of orthopedics. 2018;24(1):95–101. doi: 10.18019/1028-4427-2018-24-1-95-101Gudz AI, Denisov AO, Lasunsky SA, et al. Management of complex acetabulum fractures and their consequences. Khirurgiia (Mosk). 2017;(2):70–76. EDN: YICAVJ doi: 10.17116/hirurgia2017270-76Mehlman CT, Hubbard GW, Crawford AH, et al. Traumatic hip dislocation in children. Long-term followup of 42 patients. Clinical orthopaedics and related research. 2000;(376):68–79.Letournel E. Indications du traitement chirurgical des fractures du cotyle [Indications for surgical treatment of fractures of the acetabulum]. Chirurgie. 1990;116(4–5):435–441.Stoyukhin SS. Surgical treatment of long-standing fractures of the acetabulum. Moscow; 2016. 139 p. EDN: XBKGODClegg TE, Roberts CS, Greene JW, Prather BA. Hip dislocations — Epidemiology, treatment, and outcomes. Injury. 41(4):329–334.Heeg M, de Ridder VA, Tornetta 3rd P, et al. Acetabular fractures in children and adolescents. Clin Orthop Relat Res. 2000;(376):80–86. doi: 10.1097/00003086-200007000-00012Gänsslen A, Grechenig S, Nerlich M, Müller M. Standard Approaches to the Acetabulum Part 1: Kocher-Langenbeck Approach. Acta Chir Orthop Traumatol Cech. 2016;83(3):141–146.Letournel E. Fractures of the acetabulum. A study of a series of 75 cases. 1961. Clin Orthop Relat Res. 1994;305:5–9Tosounidis TH, Giannoudis VP, Kanakaris NK, Giannoudis PV. The Ilioinguinal Approach: State of the Art. JBJS Essent Surg Tech. 2018;8(2):e19. doi: 10.2106/JBJS.ST.16.00101Tosounidis TH, Giannoudis VP, Kanakaris NK, Giannoudis PV. The Kocher-Langenbeck Approach: State of the Art. JBJS Essent Surg Tech. 2018;8(2):e18. doi: 10.2106/JBJS.ST.16.00102Hirvensalo E, Lindahl J, Bostman O. A new approach to the internal fixation of unstable pelvic fractures. Clin Ortho Relat Res. 1993;297:28–32.Pierre G. Evolution of the Anterior Intrapelvic (Stoppa) Approach for Acetabular Fracture Surgery. J Orthop Trauma. 2015;29(Suppl 2):S1–S5. doi: 10.1097/BOT.0000000000000269Gänsslen A, Grechenig S, Nerlich M, et al. Standard Approaches to the Acetabulum Part 3: Intrapelvic Approach. Acta Chir Orthop Traumatol Cech. 2016;83(5):293–299.Hasani I, Kaftandziev I, Trpeski S, et al. The Ilioinguinal Approach versus the Anterior Intrapelvic Approach to the Acetabulum: A Review. OA Maced J Med Sci. 2013;1(1):140–147. doi: 10.3889/oamjms.2013.027