Marginal impaction is an important cause of articular incongruity that adversely affects prognosis. Radiologists should be capable of identifying posterior acetabular wall fracture patterns because they may be the first to suggest diagnoses.

Objectives: The purpose of this study was to review the epidemiological aspects of displacement fractures of the acetabulum that had been treated surgically at the National Institute of Traumatology and Orthopedics (INTO). Methods: We retrospectively analyzed 126 acetabulum fractures that had been treated surgically at INTO between March 2006 and November 2008. The following factors were taken into account: age, sex, trauma mechanism, injury classification, time elapsed between trauma and surgery, affected side and associated bone injuries. Results: 76.8% were male; the mean age was 39.6 years. The trauma mechanism was traffic accidents in 59%; the time that elapsed between injury and surgery was on average 16.4 days; 55% of the cases were on the right side; 30% of the patients presented associated fractures. Conclusion: Most of the patients were male, in an economically active age group, and were victims of traffic accidents. Edge and/or posterior column fractures were the most frequent types. Associated injuries were common and most of the fractures operated in our service came to us late.

Objectives: To present the outcomes from definitive surgical treatment for unstable fractures of the pelvic ring in children undergoing surgical reduction and stabilization. Methods: We studied 10 patients with immature skeletons who suffered unstable fractures of the pelvic ring and were treated between March 2004 and January 2008. The study was retrospective, based on clinical and radiographic evaluations. Results: The mean age at the time of the trauma was 8.8 years (2 to 13 years). Seven patients were female and three was male. There were eight cases of trauma caused by being run over, and one case each of a motorcycle accident and falling from a height. Five patients had other associated injuries such as fractures of the clavicle, femoral diaphysis, proximal humerus, lower leg bones, olecranon and bladder injury. All the patients evaluated showed an excellent clinical outcome. The pelvic asymmetry before surgery ranged from 0.7 to 2.9 cm (mean 1.45 cm), and dropped to values between 0.2 and 0.9 cm (mean 0.39 cm) after reduction. In no case was any change observed in pelvic asymmetry measured in the immediate postoperative period and at the end of follow-up. Conclusion: Pelvic ring fractures in skeletally immature patients are rare and surgical treatment is unusual. Several authors have questioned conservative treatment because of the complications encountered. Bone remodeling does not seem enough to cause an improvement in pelvic asymmetry, and this justifies the choice of surgical treatment for reduction and correction of pelvic ring deformities.

INTRODUçãONos últimos 40 anos, o tratamento das fraturas desviadas do acetábulo passou de não-cirúrgico para uma abordagem preferencialmente cirúrgica. A partir da contribuição de Letournel (1) , a redução anatômica aberta, seguida de fixação interna rígida, passou a ser considerada como padrão ouro no tratamento das fraturas desviadas do acetábulo.Antes do advento do automóvel e da motocicleta na vida moderna, esse tipo de lesão era causada essencialmente por forças em diferentes graus de intensidade em adução ou abdução do membro inferior, associadaRev Bras Ortop. 2010;45(5):474-7

InTRODUçãOA fixação iliosacral com parafuso é um método bem estabelecido para a estabilização para as lesões posteriores do anel pélvico (1) . Inserido de forma percutânea após uma redução fechada ou aberta, o parafuso iliosacral pode ser fixado ao corpo de S1, de S2 ou transfixando o ilíaco contralateral, passando por esses dois corpos vertebrais (2) .Dado o carater percutâneo da técnica, esse método depende de imagem fluoroscópica de bom padrão de qualidade, no intuito de se posicionar o parafuso dentro do "corredor de segurança anatômico", evitando-se, dessa forma, potenciais lesões iatrogênicas às estruturas neurovasculares adjacentes à fixação sacral (3) .Falta de planejamento pré-operatório; utilização inadequada da técnica; imagens fluoroscópicas de baixa Rev Bras Ortop. 2011;46(Suppl 1):40-3