Letter to the Editor: Superior Wall Fractures of the Acetabulum as a Distinct Fracture Type

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In a 16-year multicenter analysis, investigators identified 9 pediatric avulsion fractures at the superior acetabulum, near the reflected head of the rectus femoris.
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All 9 reflected-head avulsions were treated conservatively because displacement did not exceed 1 cm; none had complications, nonunion, or post-traumatic femoroacetabular impingement.
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Reflected-head avulsions result from forced knee extension with the hip flexed, whereas uncomplicated anterior inferior iliac spine avulsions follow abrupt rectus femoris straight-head contraction.
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Clinical assessment and radiography guide diagnosis, with native hip MRI used to confirm suspected reflected-head avulsion and detect labral injury; the authors favor MRI over low-dose CT in children.
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Combined pelvic-ring and superior acetabular wall injuries are extremely uncommon in children, and none occurred in the reported patient group.

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