I start out with the transfer criteria as outlined by the AAOS. We all want to be able to treat everything but it is important for all of us to understand the difference between a surgeon who may operate on an acetabulum once a month and those who fix between 6 and 10 acetabulums a week. There is a marked difference in the quality of care and complication rates and that is why the Academy has formulated these transfer criteria:

• posterior instability, any disruption posteriorly
• any bladder -urethral injury
• open pelvic fractures (which particularly require a trauma team approach)
• laterally directed forces with fractures through the iliac wing, the sacral foramina
• any open book pelvic injury with greater than 2.5 cm diastasis
• acetabular fractures

There is good evidence now that even 1 mm of acetabular displacement is associated with arthritis. If you are comfortable treating these - great. If you are not, then you have these Academy criteria to support a decision to transfer to a center with a large volume experience.