Is computed tomography cystography indicated in children with pelvic fractures?

Becker, Alexander; Yaslowitz, Ori; DuBose, Joseph J.; Peleg, Kobi; Daskal, Yaakov; Givon, Adi; Kessel, Boris

doi:10.1016/j.cjtee.2019.09.002

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…Children's organs, such as the kidneys, that are more important than other body parts, and the fat around the waist is underdeveloped and does not cushion injuries well (39). The incidence of urinary tract or bladder injury is 1.5-3.7% in patients with pelvic fractures (40).…”

Section: Pelvic Fractures and Concomitant Traumamentioning

confidence: 99%

Multicenter epidemiological survey and analysis of related factors in 10,808 hospitalized children with lower limb and pelvic fractures in China

Qiu,

Zhu,

Deng

et al. 2024

Preprint

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Purpose: To analyze the causes, locations, associated injuries, and relevant factors of lower limb and pelvic fractures in Chinese children to provide a theoretical basis for reducing the incidence of such fractures. Methods: A retrospective analysis of children with lower limb and pelvic fractures admitted to 27 tertiary children's hospitals affiliated with China's Futang Research Center of Pediatric Development between December 1, 2015, and December 31, 2019, was conducted. Inpatient cases were analyzed in the following age groups: Infants (＜2 years), Preschool children (2-5years), School children (6-11years), and Adolescents (12-18 years). Results: This study included 10,808 pediatric patients (7,152 males, 3,656 females). The proportion of preschool children of lower limb and pelvic fractures is the highest. Of the total patients, 14, 398 had lower limb and pelvic fracture sites. The shafts of the femur, tibia, and fibula, the distal tibia, distal fibula, and the pelvis were the six most common locations. Of the 734 pelvic fractures in children and adolescents, the top three locations were the ilium, pubic bone, and the ischium. Of the total patients, 9,599 underwent surgery, while 1,209 received non-surgical treatment. The three most common causes of pediatric lower limb and pelvic fractures were falling over, traffic accidents, and falling from a height. Concomitant trauma to other systems, in 1,806 cases, had respiratory trauma as the most common; the top three conditions were pulmonary contusions, traumatic pneumonia, and pneumothorax. Concomitant nervous system trauma had scalp hematoma, intracerebral hemorrhage, and subarachnoid hemorrhage as the top three conditions. Concomitant digestive trauma had traumatic liver, splenic, and pancreatic injuries as the top three conditions. Concomitant urinary trauma had traumatic renal, urethral, and perineal injuries as the top three conditions. Concomitant circulatory trauma was in 36 cases. Conclusion: The epidemiological characteristics of lower-limb and pelvic fractures in children provide valuable information. Implementing appropriate and effective preventive measures is crucial for preventing the occurrence of lower limb and pelvic fractures in children. The treatment and management of pelvic fractures and the associated multi-system injuries resulting from high-energy trauma in children require interdisciplinary teamwork to minimize the risk of mortality in the affected children.

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Section: Pelvic Fractures and Concomitant Traumamentioning

confidence: 99%

Multicenter epidemiological survey and analysis of related factors in 10,808 hospitalized children with lower limb and pelvic fractures in China

Qiu,

Zhu,

Deng

et al. 2024

Preprint

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“…Initial radiographs fail to detect acetabular fractures in 70% [29] of patients and CT is 3 commonly used [7 ▪ ]. This will identify tri-radiate cartilage involvement [8] and subtle bony or visceral injuries [31] in as many as 30% [26] of injuries to the pelvis. Pubic rami fractures are associated with visceral injury in 1% of cases, but this number increases to 15% for iliac and sacral fractures, and up to 60% for multiple fractures of the pelvic ring [4].…”

Section: Imagingmentioning

confidence: 99%

Traumatic injuries of the immature hip and pelvis

Moore,

Gnap,

Monsell

2023

Current Opinion in Pediatrics

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Purpose of review The pelvis and hip account for 0.3--4% of fractures of the immature skeleton, and generally result from high energy trauma. These fractures range in severity from apophyseal avulsions to complete disruptions of the pelvic ring. The purpose of this article is to review the presentation, diagnosis, treatment and complications of these injuries in order to inform clinicians involved in their management. There is a lack of evidence-based management protocols for fractures of the immature pelvis largely due to their rarity and lack of robust scientific literature on the topic. Recent findings Computed tomography/MRI is essential as up to 30% of pelvis and 70% of acetabular fractures are not identified on initial radiographs. A sub-optimal outcome is common in unstable fractures treated conservatively and adequate reduction and surgical stabilization is often required to avoid long-term morbidity. Summary A coordinated approach involves resuscitation and temporary stabilization with planned definitive fixation. It is generally accepted that these injures should be managed in paediatric trauma centres. Whilst injuries vary in pattern and severity, we present an overview that considers the evaluation and treatment of the paediatric patient with pelvic and hip fractures to ensure that these injuries are identified promptly and treated by surgeons familiar with contemporary management algorithms.

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“…Organs such as the kidney are relatively larger in the child, and the perirenal fat is not as well developed to cushion against injury 136 . The incidence of urinary bladder injuries is thought to be between 1.5 and 3.7% of patients with pelvic fractures 137 . Urethral injuries vary from contusion, partial rupture and complete rupture.…”

Section: Complicationsmentioning

confidence: 99%

“… 136 The incidence of urinary bladder injuries is thought to be between 1.5 and 3.7% of patients with pelvic fractures. 137 Urethral injuries vary from contusion, partial rupture and complete rupture. They may subsequently develop into strictures or fistulas that require specialist paediatric urology input.…”

Section: Complicationsmentioning

confidence: 99%

Paediatric pelvic fractures – an updated literature review

Nguyen

Drynan

Holland

2022

ANZ Journal of Surgery

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Background: Pelvic fractures in children are indicative of significant trauma. Patients will often have associated injuriessome of which require urgent intervention to prevent death and disability. Paediatric and adult pelvises respond to traumatic forces differently and distinct approaches are required for each population. Historically, pelvic fractures have been treated conservatively, but this trend is changing with a better understanding of the pelvis' inability to remodel significant deformity, as well as new techniques for operative fixation. Methods: A comprehensive search of the literature was conducted for articles published between 2000 and 2020 on paediatric pelvic fractures using medical databases including PubMed, Embase and the Cochrane Library. Results: We included 143 studies in our literature review and summarized the incidence, pathophysiology, assessment, management and complications associated with paediatric pelvic fractures. Conclusions: The rarity of paediatric pelvic fractures corresponds with a paucity of randomized clinical trials covering this topic. Trends such as the screening pelvic x-ray are derived from adult populations but are now questioned in children. Other aspects of assessment and management of these children warrant such levels of scrutiny.

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Is computed tomography cystography indicated in children with pelvic fractures?

Cited by 6 publications

References 24 publications

Multicenter epidemiological survey and analysis of related factors in 10,808 hospitalized children with lower limb and pelvic fractures in China

Multicenter epidemiological survey and analysis of related factors in 10,808 hospitalized children with lower limb and pelvic fractures in China

Traumatic injuries of the immature hip and pelvis

Paediatric pelvic fractures – an updated literature review

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