Pediatric Pelvic Injuries

Pediatric-Specific Lesions in Unstable Pelvic Ring Fractures of Skeletally Immature Children: Impact on Diagnosis and Management Decisions

“…The triradiate cartilage is susceptible to injuries through the base of pubic rami or with the quadrant lesions. 4,9,20,25 Closure of the triradiate cartilage is another important sign of pelvic bony maturity and is typically observed around 12 to 14 years in girls and 14 to 16 years in boys. 8,11…”

“…9 In addition, pubic symphysis disruption in children is typically a physeal injury through pubic apophysis chondro-osseous separation with intact symphyseal ligaments (Figure 5). 6,20 Unstable quadrant lesions involve injuries to the triradiate cartilage and are associated with segmental pelvic instability. 4,20,25 Originally described by Habacker et al, 25 unstable superior quadrant fractures consist of an ipsilateral transverse metaphyseal iliac fracture proximal to the triradiate cartilage and ipsilateral SIJ disruption.…”

“…6,20 Unstable quadrant lesions involve injuries to the triradiate cartilage and are associated with segmental pelvic instability. 4,20,25 Originally described by Habacker et al, 25 unstable superior quadrant fractures consist of an ipsilateral transverse metaphyseal iliac fracture proximal to the triradiate cartilage and ipsilateral SIJ disruption. The superior quadrant fracture variant consists of transverse failure through the triradiate cartilage (SH type 1 or 2) with ipsilateral SIJ dislocation.…”

“…The superior quadrant fracture variant consists of transverse failure through the triradiate cartilage (SH type 1 or 2) with ipsilateral SIJ dislocation. 20 Contrarily, the inferior quadrant lesion is observed in lateral compression (LC) injuries with fractures through the triradiate cartilage and additional disruption through pubic rami or pubic symphysis. 4,21 According to Ogden, 9 displaced pubic bone through the pubic apophysis chondro-osseous interface is more likely to fail further within the triradiate cartilage (the other end of the bone) rather than at the SIJ.…”

“…19 The Infolding Iliac Fractures Soft iliac wings predispose to the peculiar infolding iliac wing fracture pattern. 9,20 Infolding fracture is the equivalent to greenstick fractures of long bones in young children. Infolding iliac fractures are stable injuries caused by direct force applied to the iliac wing and might cause splitting of the overlying iliac apophysis.…”