Surgical Treatment of Unstable Pelvic Ring Injury in a Young Child

Abstract

Case: We describe an anterior and posterior pelvic ring construct, with emphasis on the posterior construct, to treat a vertical displacement fracture in a 2-year-old girl who was struck by a motor vehicle. Eighteen months after her injury, radiographs showed intact sacroiliac joints and symmetrical pubic symphysis. Conclusion: Although commonly performed in adults, pelvic fixation is challenging in children because of the small size of the child’s pelvis and osseous fixation pathways. However, this approach enabled successful vertical stabilization of the pelvis, complete resolution of symphyseal diastasis, and recovery of function and mobility.

Paediatric pelvic fractures – an updated literature review

“…Posterior ring fixation usually involves reduction of the SIJ. A wide variety of techniques exists in the literature including the use of iliosacral screws or non‐metallic implants such as osteosuturing with PDS (polydioxanone) 106,111–113 . In rare instances, spinal implants have been modified to treat younger patients with smaller anatomy 114 .…”

“…In rare instances, spinal implants have been modified to treat younger patients with smaller anatomy 114 . Surgical approaches include the ilioinguinal approach (starting with a lateral window and adding incisions as needed) or posteriorly by a paramedian incision 106,115 . Alternatively, percutaneous screws may also be inserted in a standard operating theatre with fluoroscopic guidance, as in adult pelvic surgery.…”

“…Anterior ring injuries can be fixed with a variety of fixation options including external fixation with a frame; osteosutures (non‐absorbable sutures that hold bone to bone), or plates and screws. 106 , 107 Surgical approaches include a horizontal incision (Pfannenstiel) which can be laterally extended (modified Stoppa) or a vertical incision (performed on patients with previous midline laparotomy scars).…”

“…A wide variety of techniques exists in the literature including the use of iliosacral screws or non‐metallic implants such as osteosuturing with PDS (polydioxanone). 106 , 111 , 112 , 113 In rare instances, spinal implants have been modified to treat younger patients with smaller anatomy. 114 Surgical approaches include the ilioinguinal approach (starting with a lateral window and adding incisions as needed) or posteriorly by a paramedian incision.…”

“… 114 Surgical approaches include the ilioinguinal approach (starting with a lateral window and adding incisions as needed) or posteriorly by a paramedian incision. 106 , 115 Alternatively, percutaneous screws may also be inserted in a standard operating theatre with fluoroscopic guidance, as in adult pelvic surgery. There are also case reports of percutaneous screws being inserted within an interventional radiology setting using CT to assist in positioning and planning of the screw pathway.…”