Analysis of the Cause, Classification, Treatment, Outcome and Associated Injuries of Pediatric Pelvic Ring Fractures

Sağlam, Yavuz; Dikmen, Göksel; Bademler, Süleyman; Aksoy, Murat; Dikici, Fatih

doi:10.5505/tjtes.2015.14868

Cited by 8 publications

(14 citation statements)

References 18 publications

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“…Morel Lavallee lesions caused by the shearing of subcutaneous fat and skin from the underlying fascia may occur, particularly in older, obese pediatric patients. 16 In the presence of pelvic fractures, a GU exam with rectal and vaginal exams are necessary to assess for open fractures. The plasticity of the immature pelvis may result in severe deformity at the time of injury that rebounds prior to radiographic examination which can lead to missed open fractures in the lower gastrointestinal or GU tract.…”

Section: Diagnosismentioning

confidence: 99%

Pediatric Pelvic and Acetabular Fractures: Diagnosis, Treatment, and Outcomes

Lopreiato¹,

Ramalingam²

2022

Journal of the Pediatric Orthopaedic Society of North America

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Pediatric orthopaedic surgeons routinely care for patients who sustain trauma due to unintentional injuries, including transportation-related injuries. While pelvic ring and acetabulum fractures are uncommon in this patient population, these injuries require thorough evaluation and individualized treatment to reduce associated morbidity and mortality. Trauma patients with pelvic fractures often have concomitant injuries to other organ systems, and their initial evaluation and management must begin with stabilization and evaluation for central nervous system and visceral injuries. A thorough orthopaedic evaluation is necessary to identify other extremity fractures and to determine the optimal treatment. Diagnosis and treatment of pediatric pelvic fractures is challenging due to the unique anatomy of the growing pelvis and varying injury patterns throughout childhood and adolescence. Radiographs and computed tomography can aid in appropriately classifying these fractures and aid in surgical planning. Fracture stability and deformity determine the need for surgical stabilization. Most pediatric pelvic fractures can be treated nonoperatively. For those that require surgical treatment, anterior and posterior pelvic fixation can be safely performed with appropriate planning and knowledge of the skeletally immature pelvis. Satisfactory outcomes can be obtained with correction of residual deformity or pelvic asymmetry less than 1 cm. The management of pediatric acetabulum fractures is similarly unique as treatment considerations include injury to the triradiate cartilage in addition to articular congruency and hip joint stability. The mechanism of injury in acetabulum fractures is frequently high energy trauma, however low energy mechanisms have been reported. MRI imaging is helpful to visualize the full extent of injury to the cartilaginous portions of the joint. Surgical intervention is reserved for patients with hip join instability, acetabulum incongruity >2mm, or failure to maintain a concentric reduction after attempt at closed management. Although acetabulum fractures can result in early osteoarthritis and disturbances in acetabular development, favorable results are seen with both operative and nonoperative management.

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Section: Diagnosismentioning

confidence: 99%

Pediatric Pelvic and Acetabular Fractures: Diagnosis, Treatment, and Outcomes

Lopreiato¹,

Ramalingam²

2022

Journal of the Pediatric Orthopaedic Society of North America

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“…[14] Triradiat kıkırdağın açık olduğu durumlarda daha çok, Torode ve Zieg, Tip II ve III yaralanmalar görülürken; matürasyonla birlikte, asetabular ve posterior halkayı içeren, daha instabil ve komplikasyona açık kırıklar oluşabilmektedir. [15] Güncel bilgilere bakıldığında pek çok yazar, geçmişte olduğu gibi, çocukluk çağında görülen ve özellikle immatür pelvis kırıkları için; yatak istirahati, iskelet traksiyonu veya pelvipedal alçılama gibi konservatif yöntemleri ön planda tutmaktadır. [8,[13][14][15][16] İnstabil kırıkları içeren güncel geriye dönük çalışmalara göre, uzun dönem morbidite sonuçları nedeniyle, özellikle de triradiat kıkırdak hasarı gibi durumlarda, gelişebilecek deformite ve büyüme bozukluklarına yönelik cerrahi tedaviye yönelimde artış söz konusudur.…”

Section: çOcuklarda Pelvis Ve Asetabulum Kırıklarıunclassified

“…[15] Güncel bilgilere bakıldığında pek çok yazar, geçmişte olduğu gibi, çocukluk çağında görülen ve özellikle immatür pelvis kırıkları için; yatak istirahati, iskelet traksiyonu veya pelvipedal alçılama gibi konservatif yöntemleri ön planda tutmaktadır. [8,[13][14][15][16] İnstabil kırıkları içeren güncel geriye dönük çalışmalara göre, uzun dönem morbidite sonuçları nedeniyle, özellikle de triradiat kıkırdak hasarı gibi durumlarda, gelişebilecek deformite ve büyüme bozukluklarına yönelik cerrahi tedaviye yönelimde artış söz konusudur. [2,8] Güncel bilgilere göre farklı kırık tipleri için önerilen tedavi yöntemleri Tablo 2'de paylaşılmıştır.…”

Section: çOcuklarda Pelvis Ve Asetabulum Kırıklarıunclassified

“…Ancak, özellikle triradiat kıkırdağı içeren kırıklarda, büyüme alanının erken kapanması, bacak boyu eşitsizliği, pelvik asimetri, skolyoz, travmatik artritler, bel ağrısı, sakral kırıklara bağlı sinir kök yaralanmaları gibi bir takım istenmeyen durumlar da bildirilmiştir. [5,8,15,18] Tablo 1. Torode ve Zieg pelvis kırığı sınıflandırma sistemi [6] Tip Tanımlama kırıklarda özellikle triradiat kıkırdağın yaralanması önemli bir yer tutmaktadır.…”

Section: çOcuklarda Pelvis Ve Asetabulum Kırıklarıunclassified

“…elde edilmiştir. [24] On altı erkek, 10 kızın dâhil olduğu çalışmada, ortalama yaş 10,5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16), ortalama yatış süresi 3,5 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) gün idi. On dört hastada araç dışı, iki hastada araç içi olmak üzere toplam 16 hastada trafik kazası; 10 hastada ise yüksekten düşme sonrası pelvis yaralanması mevcuttu.…”

Section: Kompleks Kırıklarunclassified

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Çocuklarda pelvis ve asetabulum kırıkları

Erkuş¹,

Turgut²

2019

TOTBID

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Türk Ortopedi ve Travmatoloji Birliği Derneği daha kalın ve daha güçlü "periosteum"a ve yaşla birlikte azalan remodelasyon özelliğine; sakroiliak eklem ve "simfizis pubis" ise artmış esnekliğe sahiptir. Bu özellikleri nedeniyle, pelvik bölge kırıklarının oluşması için yetişkin kemiğine göre daha yüksek enerji gerekir. Ancak unutulmamalıdır ki; düşük enerjili yaralanmalar sonrası avulsiyon kırıkları ya da stabil halka kırıkları gibi kırıkların görülmesi de mümkündür. [2]

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The clinical characteristics and management of paediatric pelvic fractures: a changing landscape based on skeletal maturity

Gowrishankar

Arshad

et al. 2022

Eur J Trauma Emerg Surg

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Introduction Paediatric pelvic fractures (PPFs) are uncommon but signify serious trauma. A comprehensive multidisciplinary approach is needed due to a high number of associated injuries. This study aims to retrospectively analyse PPFs over a 5-year period and evaluate how advancing skeletal maturity changes fracture patterns and management plans. Methods The trauma database was retrospectively reviewed for pelvic fractures in patients aged ≤ 18 years. Radiographs and CT scans were used to classify pelvic injuries according to the modified Torode classification and determine the status of the triradiate cartilage (open: skeletally immature; closed: skeletally mature). Data collected also included the mechanism of injury, clinical and functional outcomes, and associated injuries. Logistic regression analysis was performed to identify risk factors for associated abdominal injuries. Results 65 PPFs (2.8% of paediatric trauma admissions during the study period) were classified as type I (3.1%), type II (7.7%), type IIIa (32.3%), type IIIb (38.5%), type IV (18.5%) according to the modified Torode classification. The mean age was 13.41 ± 3.82. Skeletally immature children were more likely to be hit by a motor vehicle as a pedestrian (p < 0.001), be intubated (p = 0.009), acquire Torode type II (p = 0.047) and rami fractures (p = 0.037), and receive chest (p = 0.005) and head injuries (p = 0.046). Skeletally immature children were also less likely to acquire Torode type IV fractures (p = 0.018), receive surgical treatment for their pelvic injuries (p = 0.036), and had a faster time to full weight bearing (p = 0.013). Pelvis AIS score ≥ 4 (OR 5.3; 95% CI 1.3–22.6; p = 0.023) and a pedestrian accident (OR 4.9; 95% CI 1.2–20.7; p = 0.030) were risk factors for associated abdominal injuries. There was a strong association between a higher pelvic fracture grade and the proportion of patients with closed triradiate cartilage (p = 0.036), hospital length of stay (p = 0.034), mean pelvic AIS score (p = 0.039), a pelvis AIS score of ≥ 4 (p = 0.022), mean ISS (p = 0.003), an ISS score between 25 and 75 (p = 0.004), average time to FWB (p = 0.001), requirement of blood products (p = 0.015), and a motor vehicle accident (p = 0.037). Conclusion PPFs occurring in skeletally mature and immature patients are significantly different in terms of mechanism of injury, fracture severity, fracture pattern, and management strategy. There is a high rate of associated injuries, necessitating an integrated multidisciplinary approach in paediatric trauma centres.

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Analysis of the Cause, Classification, Treatment, Outcome and Associated Injuries of Pediatric Pelvic Ring Fractures

Cited by 8 publications

References 18 publications

Pediatric Pelvic and Acetabular Fractures: Diagnosis, Treatment, and Outcomes

Pediatric Pelvic and Acetabular Fractures: Diagnosis, Treatment, and Outcomes

Çocuklarda pelvis ve asetabulum kırıkları

The clinical characteristics and management of paediatric pelvic fractures: a changing landscape based on skeletal maturity

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