Pediatric Pelvic Fractures: A Marker for Injury Severity

Abstract

Pelvic fractures comprise a small number of annual Level I pediatric trauma center admissions. This is a review of the University of Chicago Level I Pediatric Trauma Center experience with pediatric pelvic fractures. This is a retrospective review of the University of Chicago Level I Pediatric Trauma Center experience with pediatric pelvic fractures during the 12-year period from 1992 to 2004. From 1992 to 2004, there were 2850 pediatric trauma admissions. Thirteen patients were identified with pelvic fractures; seven were boys and six were girls. The average age was 8 years old. The mechanism of injury in all cases was motor vehicle related; 11 patients (87%) sustained pedestrian-motor vehicle crashes. According to the Torode and Zeig classification system, type III fractures occurred in eight patients (62%) and type IV fractures occurred in six patients (31%). Associated injuries occurred in eight patients (62%). Seven of these patients (88%) had associated injuries involving two or more organ systems. Of the associated injuries, additional orthopedic injuries were the most common, occurring in 62 per cent of our patients. Neurological injuries occurred in 54 per cent of patients, vascular injuries in 39 per cent, pulmonary injuries in 31 per cent, and genitourinary injuries in 15 per cent. Five patients (38%) were treated operatively; only two patients underwent operative management directly related to their pelvic fracture. The remaining three patients underwent operative management of associated injuries. The mortality rate was 0 per cent. Although pelvic fractures are an uncommon injury in pediatric trauma patients, the morbidity associated with these injuries can be profound. The majority of pelvic fractures in children are treated nonoperatively, however, more than one-half of these patients have concomitant injuries requiring operative management. When evaluating and treating pediatric pelvic fractures, a systematic multidisciplinary approach must be taken to evaluate and prioritize the pelvic fracture and the associated injuries.

Pelvic fractures in children and adolescents in polytrauma and high-energy injuries

“…Zła ma nia mied ni cy u dzie ci i do ra sta ją cych są dość rzad kie, a czę stość wy stę po wa nia we dług wie lu au to rów spo śród wszyst kich ura zów dzie cię cych wa ha się od 0,2-7,5% [1][2][3][4][5][6][7][8][9]. Do naj częst szych oko licz no ści, w któ rych do cho dzi do zła mań mied ni cy na le żą: wypad ki ko mu ni ka cyj ne, upad ki z wy so ko ści, ura zy sporto we [1,3,5,7,8,[10][11][12]. Naj czę ściej są to izo lo wa ne zła ma nia sta bil ne, któ re nie wy ma ga ją in ter wen cji chirur gicz nej, szcze gól nie w zła ma niach awul syj nych oraz zła ma niach pro stych, w któ rych le cze nie za cho wawcze da je do bre wy ni ki [7,8,10,11,13].…”

“…Naj czę ściej są to izo lo wa ne zła ma nia sta bil ne, któ re nie wy ma ga ją in ter wen cji chirur gicz nej, szcze gól nie w zła ma niach awul syj nych oraz zła ma niach pro stych, w któ rych le cze nie za cho wawcze da je do bre wy ni ki [7,8,10,11,13]. Jed nak po zo staje gru pa zła mań nie sta bil nych, wy ma ga ją cych in terwen cji ope ra cyj nej, szcze gól nie w ura zach wie lo narzą do wych, wy so ko ener ge tycz nych, gdzie ist nie je niebez pie czeń stwo po wa żnych po wi kłań, łącz nie ze zgonem wy stę pu ją cym na wet do 14% przy pad ków [1,4,5,9,12,14,15].…”

“…Zła ma nia w ob rę bie mied ni cy u dzie ci i do ra stają cych na le żą do rzad kich ob ra żeń. Śred ni wiek pacjen tów pe dia trycz nych do zna ją cych ura zów w ob rębie mied ni cy to 7,4-12,2 lat [1,6,8,17,18]. W za leżno ści od sta nu ogól ne go, ura zów współ to wa rzy szących, ty pu ura zu mied ni cy, oraz mo żli wo ści technicz nych (sprzę tu ope ra cyj ne go), ura zy są kwa li fi kowa ne do le cze nia za cho waw cze go, bądź ope ra cyj nego [5,14,15,[18][19][20].…”

“…Pelvic fractures in children and adolescents are quite rare, their incidence (according to numerous authors) varying from 0.2% to 7.5% of all pediatric injuries [1,2,3,4,5,6,7,8,9]. Pelvic fractures occur most often following road accidents, falls from height, and sports injuries [1,3,5,7,8,10,11,12]. The most common presentation is that of an isolated stable fracture that does not require surgical intervention.…”

“…This is particularly the case with avulsion and simple fractures, where conservative treatment produces good results [7,8,10,11,13]. However, there is a group of unstable fractures requiring surgical intervention, seen particularly with polytrauma and high-energy injuries, in which there is a danger of serious complications, including death (which occurs in up to 14% of cases) [1,4,5,9,12,14,15].…”