FP17.1 Outcomes of Surgical Hip Dislocation for Sports Related Posterior Wall Acetabular Fractures in Adolescent Patients

Abstract

Abstract ICL17 - The Full Picture: Shaping the Future of Global Hip Preservation, Ground Floor Session Room (BMCC Level 0), October 9, 2026, 14:00 - 16:00 Background Posterior wall acetabular fractures are uncommon but significant injuries in the pediatric population. Traditional management via the Kocher-Langenbeck approach relies on fluoroscopic indirect reduction and may limit intraoperative visualization. Surgical hip dislocation (SHD) offers direct access to the acetabulum and femoral head, enabling comprehensive fracture reduction and treatment of concomitant pathology. This study presents the largest reported cohort of pediatric posterior wall acetabular fractures treated via the SHD approach, evaluating outcomes and identifying morphologic risk factors associated with injury. Methods A single-center retrospective case series was conducted at Boston Children's Hospital, including patients aged 8–19 years diagnosed with a posterior wall acetabular fracture that occurred while playing sports and were treated with open reduction and internal fixation via SHD between 2000 and 2025. Patients with congenital comorbidities or prior ipsilateral hip surgery were excluded. Primary outcomes included return to full unrestricted activity, time to return to activity. Secondary outcomes included complication rate and revision surgery rate. Morphologic parameters, including acetabular version, alpha angle, posterior wall index, lateral center-edge angle (LCEA), and femoral anteversion, were measured on the affected and contralateral unaffected sides and compared using paired statistical analyses. Results Twenty-three patients were included (mean age 15.9±4.0 years; 91.3% male). Football accounted for 34.8 % of the cases. 56.5% of patients had documented hip dislocation at presentation. Intraoperatively, incarcerated fracture fragments were found in 47.8% and incarcerated labrum in 17.4%. Concomitant procedures included femoral osteochondroplasty (56.5%) and labral repair (47.8%). At a mean follow-up of 24.3 ± 22.8 months, 78.3% of patients returned to full activities at a mean of 6.7 ± 4 months. Complications occurred in 8.7% (one avascular necrosis, one hip subluxation) requiring revision surgery. Morphologic analysis revealed significantly reduced proximal acetabular version on the affected side compared to the contralateral hip (−7° ± 9.2° vs. −2.7° ± 6.4°; p = 0.01) and reduced central acetabular version (7.7° ± 6.4° vs. 10.1° ± 4.4°; p = 0.029). Conclusion Surgical hip dislocation is a safe and effective approach for the management of posterior wall acetabular fractures in pediatric patients, with a high rate of return to full activity and low revision surgery rates. Reduced acetabular version on the affected side may represent a predisposing morphologic risk factor for injury, particularly in sports-related mechanisms. These findings support the utility of SHD as a preferred surgical approach and highlight the importance of morphologic assessment in this population.