Lower genitourinary injury and pelvic fractures in pediatric patients

Pediatric and Adult Blunt Traumatic Bladder Rupture: A Comparative Review

“…Bladder rupture is more common in young-to-middle age males with severe polytrauma as evidenced by a high ISS and mortality. 9,17,19 Interestingly, five of our pediatric patients were female and three were male. This gender variation is likely random, due to our low patient number.…”

“…20 Tarman et al recommended that pediatric patients with pelvic fracture without gross hematuria or multiple associated injuries do not warrant further cystographic evaluation. 17 All of our pediatric patients had multiple associated injuries, so it is difficult for us to comment on those without other injuries. The best diagnostic modality to detect BR is debated.…”

Malgaigne Pelvic Fractures in Children- an unusual unstable fracture pattern of pelvic fractures

“…Although controversial, most authors agree that microhematuria can be followed expectantly, whereas patients with gross hematuria should undergo imaging with abdominopelvic computed tomography (CT), retrograde urography, and cystography [29].…”

“…Vaginal and/or rectal lacerations occur in 2-18% of children with pelvic fractures [28][29][30][31]. Their detection and treatment with repair or diversion is of paramount importance to prevent late pelvic abscess formation [32].…”

“…Operative treatment of pelvic fractures is not routinely recommended [49] because (a) exsanguinating hemorrhage is unusual in children, so operative pelvic stabilization to control bleeding is not necessary [28,49]; (b) pseudoarthrosis is rare in children and fixation is not necessary to promote healing; (c) the thick periosteum in children tends to help in stabilizing the fracture, so surgery is usually not necessary to obtain stability [29]; (d) prolonged immobilization is not necessary for the fracture healing [48]; (e) significant remodeling may occur in skeletally immature patients [49]; and (f) long-term morbidity after pelvic fracture is uncommon in children [19,28,50].…”