Complex Open Pelvic Fracture in an 8-Year-Old Girl Treated With INFIX—A Case Study

Abstract

We describe the case of an 8-year old female patient with an open pelvic fracture after being run over by a bus. Open pelvic injuries in pediatric patients are very rare and are associated with high mortality rates and long-term morbidity. In this case, a multidisciplinary surgical approach is described. The injuries include a complex pelvic ring fracture, which was treated with an internal external fixator, together with severe urogenital and soft-tissue injury. The internal external fixator, a surgical technique involving a temporary internal fixation device, is well described in adults, but has not been described in pediatric patients before. This case presentation shows the severity and complexity of the treatment of open pelvic fractures with severe associated injures. Albeit the treatment of her orthopaedic injuries has been successful so far, our patient unfortunately still suffers notable morbidity from her other injuries.

Paediatric pelvic fractures – an updated literature review

“…Alternatively, osteosutures may have an advantage in open pelvic fractures as they can reduce the need for further dissection and the risk of infection as there is no metalware inserted 108 . New techniques include the use of an INFIX (Internal External Fixator) device for in children; this has been described for use in adults 109 . In an 8‐year‐old female with an MTZ IV injury, the INFIX was inserted without difficulty, held the reduction for 8 weeks before successfully removal and provided a less bulky and invasive alternative to external fixation 109 .…”

“…New techniques include the use of an INFIX (Internal External Fixator) device for in children; this has been described for use in adults 109 . In an 8‐year‐old female with an MTZ IV injury, the INFIX was inserted without difficulty, held the reduction for 8 weeks before successfully removal and provided a less bulky and invasive alternative to external fixation 109 . Surgeons should be mindful of injury to the lateral cutaneous nerve of the thigh by INFIX devices 110 .…”

“… 109 In an 8‐year‐old female with an MTZ IV injury, the INFIX was inserted without difficulty, held the reduction for 8 weeks before successfully removal and provided a less bulky and invasive alternative to external fixation. 109 Surgeons should be mindful of injury to the lateral cutaneous nerve of the thigh by INFIX devices. 110 Otherwise, pubic symphysis displacement of more than 2 cm can be fixed with plates and screws.…”

Management and outcome of pelvic fracture associated with vaginal injuries: a retrospective study of 25 cases

“…It might be considered as an underestimated issue in the care of high energy blunt pelvic trauma in female patients. However, studies of pelvic fractures associated with vaginal injuries are rare and most are case reports which mainly present treatment process and clinical outcomes [11–14] but lack of a systemic study. Considering the anatomical relationship, fractured segments of pelvic ring may increase the risk of vaginal injury.…”

Management and outcome of pelvic fracture associated with vaginal injuries: a retrospective study of 25 cases

“…It might be considered as an underestimated issue in the care of high energy blunt pelvic trauma in female patients. However, studies of pelvic fractures associated with vaginal injuries are rare and most are case reports which mainly presented on treatment process and clinical outcomes [11][12][13][14] but lack of a systemic study. Considering the anatomical relationships, fractured segments of pelvic ring may increase the risk of vaginal injury.…”