Clinical characteristics, injury pattern and management of pediatric pelvic fracture: An observational retrospective study from a level I trauma center

Abstract

Background Pediatric pelvic fractures (PPF) are uncommon among children requiring hospitalization after blunt trauma. The present study explored our experience for the prevalence, patients demographics, clinical characteristics, injury pattern and management of pediatric pelvic fractures in a level I trauma center. Methods This is a retrospective review of prospectively collected data obtained from trauma registry database for all pediatrics trauma patients of age ≤18 years. Data were analyzed according to different aspects relevant to the clinical applications such as Torode classification for pelvic ring fracture (Type I–IV), open versus closed triradiate cartilage, and surgical versus non-surgical management. Results During the study period (3 and half years), a total of 119 PPF cases were admitted at the trauma center (11% of total pediatric admissions); the majority had pelvic ring fractures (91.6%) and 8.4% had an acetabular fracture. The mean age of patients was 11.5 ± 5.7, and the majority were males (78.2%). One hundred and four fractures were classified as type I (5.8%), type II (13.5%), type III (68.3%) and type IV (12.5%). Patients in the surgical group were more likely to have higher pelvis AIS (p = 0.001), type IV fractures, acetabular fractures and closed triradiate cartilage as compared to the conservative group. Type III fractures and open triradiate cartilage were significantly higher in the conservative group (p < 0.05). Patients with closed triradiate cartilage frequently sustained spine, head injuries, acetabular fracture and had higher mean ISS and pelvis AIS (p < 0.01) than the open group. However, the rate of in-hospital complications and mortality were comparable among different groups. The overall mortality rate was 2.5%. Conclusion PPF are uncommon and mainly caused by high-impact trauma associated with multisystem injuries. The majority of PPF are stable, despite the underlying high-energy mechanism. Management of PPF depends on the severity of fracture as patients with higher grade fractures require surgical intervention. Furthermore, larger prospective study is needed to understand the age-related pattern and management of PPF.

Secure paediatric pelvic fracture external fixation using an intraoperative support device

“… 13 The pelvic fracture itself is often stable and treated conservatively, although it is often complicated by other traumatic injuries, such as thoracoabdominal injuries. 14 However, surgical treatment is indicated for unstable paediatric fracture type. 15 This case had multiple traumas including subarachnoid haemorrhage, bilateral traumatic pneumothorax, retroperitoneal haematoma and pelvic fracture, classified as 61B2.3 by the AO classification and type IV by Torode and Zieg classification.…”

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

“…3,4 Pediatric pelvic fractures are present in less than 8% of all Level 1 pediatric blunt trauma admissions. [3][4][5][6][7] Seventy-five percent of pediatric pelvic fractures are sustained during transportationrelated injuries, including motor vehicle collisions and pedestrians struck by motor vehicles. 8 These injury mechanisms require comprehensive work up for concomitant injuries, which include central nervous system (CNS) injuries, thoracic and visceral injuries, extremity fractures, and genitourinary (GU) injuries.…”

“…Vascular properties of children allow for swift and effective vasoconstriction of smaller diameter vessels which also reduces intrapelvic bleeding. 4,6,7,14…”

Paediatric pelvic fractures – an updated literature review

“…The need for blood transfusion is varied but is estimated between 11% and 39.5% of all paediatric pelvic fracture patients 9,13,19,23,24,31,66,98,99 . On average, patients who did need transfusion received 3.7 units of packed red blood cells 100 .…”

“…33,93,[95][96][97] The need for blood transfusion is varied but is estimated between 11% and 39.5% of all paediatric pelvic fracture patients. 9,13,19,23,24,31,66,98,99 On average, patients who did need transfusion received 3.7 units of packed red blood cells. 100 Those with MTZ type III-B (16 out of 39 children) were more likely to need a blood transfusion compared those with a type III-A (7 out of 43) (OR 3.58; 95% CI 1.28-10.03).…”