Analysis of pelvic fracture pattern and overall orthopaedic injury burden in children sustaining pelvic fractures based on skeletal maturity

Abstract

Purpose The purpose of this study was to review pelvic fractures and concomitant orthopaedic injuries in children who have a patent triradiate cartilage (TRO) compared with children whose triradiate cartilage has closed (TRC). We hypothesise that these injuries will differ, leading to correlated alterations in management.Patients and Methods Using a database, we retrospectively reviewed patients aged below 18 years with pelvic fractures presenting to our Level 1 trauma center. Radiographs and CT scans were reviewed to identify orthopaedic injuries and categorise pelvic injuries using the modified Torode classification between the two groups.Results A total of 178 patients met inclusion criteria (60 TRO and 118 TRC). Mean age ± SD for TRO and TRC groups were 8 ± 4 years and 16 ± 2 years, respectively. TRO patients were more likely to present as a pedestrian struck by a vehicle (odds ratio (OR) 6.0; p < 0.001) and less likely to present after a motor vehicle collision (OR 0.2; p < 0.001). TRO patients were more likely to sustain rami fractures (OR 2.1; p = 0.020) and Torode IIIA injuries (OR 3.6; p < 0.001). They were less likely to sustain acetabular fractures (OR 0.5; p = 0.042), sacral fractures (OR 0.4; p = 0.009), hip dislocations (p = 0.002) and Torode IV injuries (OR 0.4; p = 0.004). TRO patients were less likely to be treated operatively for their pelvic (OR 0.3; p = 0.013) and orthopaedic injuries (OR 0.4; p = 0.006). ConclusionWe suggest that patients with open triradiate cartilage are unique. Their pelvic injuries may be treated more conservatively as they have a greater potential for periosteal healing and bone remodelling. Patients with closed triradiate cartilage should be treated similarly to adults, as they share a similar mechanism of injury and need for operative fixation.

Comparative Study of Percutaneous Sacroiliac Screw with or without TiRobot Assistance for Treating Pelvic Posterior Ring Fractures

“…The Advantages of TiRobot Over Traditional Surgical Techniques Biomechanical studies confirmed that the stability of the anterior and posterior pelvic rings accounted for 40% and 60% [27][28][29][30] . The stability of the posterior pelvic ring is maintained by the sacroiliac joint complex, which is composed of the bilateral ilium, the sacrum, the sacroiliac joint, and the surrounding ligaments; it also plays an important role in the stability of the pelvic ring 21 .…”

Paediatric pelvic fractures – an updated literature review

“…This is supported by several studies, which found that children with an open triradiate cartilage (i.e. more immature) were also likelier to be hit by automobiles 38,40 . Children are also more likely to sustain a lateral compression pelvic injury in contrast to adults, who usually sustain an antero‐posterior compression injury 37 .…”

“…more immature) were also likelier to be hit by automobiles. 38,40 Children are also more likely to sustain a lateral compression pelvic injury in contrast to adults, who usually sustain an antero-posterior compression injury. 37 Crashes involving vehicle intrusion or older children (age > 12 years old) increased the likelihood of pelvic fractures.…”

Surgical management of paediatric pelvic fractures: a prospective case series and early experience from a level one Egyptian trauma centre

“…Anatomically, the immature pediatric patient skeleton offers better flexibility with greater joint (sacroiliac and symphysis pubis) laxity and abundant cartilage, which allows for superior shock absorption and an increased remodeling potential [7,24]. These inherent characteristics of the paediatric patients' pelvis encouraged more nonsurgical lines for PPF management, including bed rest, traction, pelvic slings, or hip spica casts [12,[25][26][27].…”