Paediatric pelvic fractures: How do they differ from adults?

Hermans, Erik; Cornelisse, S T; Biert, J.; Tan, Edward; Edwards, Michael J.

doi:10.1302/1863-2548-11-160138

Cited by 30 publications

(36 citation statements)

References 25 publications

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“…On the other hand, femoral and tibia fractures were the most common associated fractures in the limbs. In contrast, spine fracture, mainly thoracic spine, was the most common associated fracture in the axial skeleton [3,5,19] which is similar to our findings. The 24-h mortality for pediatrics polytrauma patients is related to many factors, including the injury severity score; patients associated with higher ISS scores were hemodynamically unstable and required blood transfusion.…”

Section: Discussionsupporting

confidence: 91%

“…High-energy blunt trauma is the leading mechanism of pediatric pelvic fractures primarily due to motor vehicle accidents and fall from height [2][3][4]. Pelvic fracture in pediatric population is a marker of the injury severity which showed association with injuries to the head and intra-abdominal region and greater risk of hemorrhage [2,8,9].…”

Section: Introductionmentioning

confidence: 99%

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

Alhammoud

Moghamis

Abdelrahman

et al. 2021

BMC Musculoskelet Disord

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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.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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

Alhammoud

Moghamis

Abdelrahman

et al. 2021

BMC Musculoskelet Disord

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“…This mechanism of injury is not uncommon, but the fact that a tractor was involved contributed to the severity of the injury. The majority of pelvic fracture in children occur due to pedestrian motor vehicle accidents (MVA), followed by passenger MVA; other reported modes of injury include falls, sport injuries, bicycle injuries and driveway injuries [ 2 , 3 , 7 ]. Additionally, Shaath et al [ 12 ] found that children with open triradiate cartilage are more likely to suffer from injuries due to pedestrian MVA, which results in lateral compression-type injuries, while children with open triradiate cartilage are more likely to suffer from passenger MVA, which mimics antero-posterior compression-type injuries.…”

Section: Discussionmentioning

confidence: 99%

“…Open pelvic fractures are even less common and only account for between 0.6 and 12.9% of all pelvic fractures in children. The majority of these injuries are caused by road traffic accidents [ 4 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Open complete anterior dislocation of the sacro-iliac joint in a 4-year-old boy: a case report of a rare injury with 5-year follow-up

Elnahal¹,

Fahmy²,

Acharya³

2017

Strategies in Trauma and Limb Reconstruction

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Pelvic fractures are uncommon in children and account for between 0.3 and 7.5% of all pediatric injuries. Open pelvic fractures only account for up to 12.9% of all pediatric pelvic fractures. An unusual case of open complete anterior sacro-iliac joint dislocation in a 4-year-old boy is presented with a long-term follow-up. The multidisciplinary approach is reported with review of the current literature. A 4-year-old male presented to our institution in January 2012 after having been run over by a tractor. He presented with gross hemodynamical instability, MISS of 25, and an unstable lateral compression type III pelvic fracture with complete anterior dislocation of the left hemipelvis and a groin wound extending into the left thigh. The patient was managed in accordance with the ATLS and open fracture guidelines. Reduction in the dislocated SI joint was achieved via a posterior approach to the SI joint, followed by fixation with 2K wires in S1 and S2 sacral segments, with an anterior external fixator. Pelvic asymmetry post-reduction was 0.9 cm, compared to 16 cm post-injury, and asymmetry persisted till final follow-up at 5 years. At 5 years, patient regained full function, including recreational sport activities. Patients scored a 96/96 on the Majeed score (after excluding 4 points for sexual function). We believe that posterior reduction in an anteriorly dislocated SI joint in the pediatric population is a viable option. A coordinated, multidisciplinary approach and restoration of pelvic ring stability can lead to optimal outcome.

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“…When more than minor injury is suspected in these instances, computed tomography (CT) of the abdomen and pelvis is the most helpful for diagnosis of bony traumatic findings [ 1 – 3 ]. Currently, pelvic radiograph is recommended routinely for pediatric patients with altered level of consciousness or other distracting injuries which may result in lower reliability of the physical examination of the pelvis [ 4 ]. When significant injury to the pelvis is suspected, CT will often be performed due to additional suspected injury in the abdomen.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of Pelvic Radiographs in the Initial Trauma Evaluation with Concurrent CT: Is Additional Radiation Exposure Necessary?

Misiura

Nanassy

Urbine

2018

International Journal of Pediatrics

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Trauma patients in a Level I Pediatric Trauma Center may undergo CT of the abdomen and pelvis with concurrent radiograph during initial evaluation in an attempt to diagnose injury. To determine if plain digital radiograph of the pelvis adds additional information in the initial trauma evaluation when CT of the abdomen and pelvis is also performed, trauma patients who presented to an urban Level I Pediatric Trauma Center between 1 January 2010 and 7 February 2017 in whom pelvic radiograph and CT of the abdomen and pelvis were performed within 24 hours of each other were analyzed. A total of 172 trauma patients had pelvic radiograph and CT exams performed within 24 hours of each other. There were 12 cases in which the radiograph missed pelvic fractures seen on CT and 2 cases in which the radiograph suspected a fracture that was not present on subsequent CT. Furthermore, fractures in the pelvis were missed on pelvic radiographs in 12 of 35 cases identified on CT. Sensitivity of pelvic radiograph in detecting fractures seen on CT was 65.7% with a 95% confidence interval of 47.79-80.87%. Results suggest that there is no added diagnostic information gained from a pelvic radiograph when concurrent CT is also obtained, a practice which exposes the pediatric trauma patient to unnecessary radiation.

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Paediatric pelvic fractures: How do they differ from adults?

Cited by 30 publications

References 25 publications

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

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

Open complete anterior dislocation of the sacro-iliac joint in a 4-year-old boy: a case report of a rare injury with 5-year follow-up

Usefulness of Pelvic Radiographs in the Initial Trauma Evaluation with Concurrent CT: Is Additional Radiation Exposure Necessary?

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