Therapeutic effect of an external fixator in the treatment of unstable pelvic fractures in children

Surgical management of paediatric pelvic fractures: a prospective case series and early experience from a level one Egyptian trauma centre

“…Approximately half were a pin tract infection after the external fixator application, which was conservatively treated and completely resolved following implant removal. In contrast, Zhu et al reported a pin tract infection occurring in 7.5% of their series [11]. Furthermore, six patients had a residual vertical migration resulting in LLD, which was < 1 cm and was tolerated by the patients.…”

“…The most common surgical intervention was open reduction and internal fixation (ORIF) with or without ISS fixation (83.6%), followed by percutaneous screw fixation alone (7.2%) and external fixation with or without ISS (5.2%). The study by Zhu et al included 40 patients with a mean age of 5.9 ± 3.1 (range, 2-14.5) years; although all the patients were diagnosed with unstable PPF, they were treated with an external fixator alone; however, patients diagnosed with fracture type C (22 patients) had post-operative traction to control the vertical element [11]. So, we believe that the area of choosing the best fixation tool still needs further investigation.…”

“…For functional assessment, we used a modification of the Majeed functional scoring system [20] since it is specific for pelvic fractures, and we achieved excellent outcomes in 93.3% of our patients; however, it was not frequently utilized in PPF outcome assessment which made it difficult to compare our results with previous reports. Signorino et al [35] and Zhu et al [11] used the more general WeeFIM instrument (formerly known as the Functional Independence Measure for Children), which assesses self-care, mobility, and cognition. In a recent study by Fahmy and Abdelmoneim, including 21 surgically treated patients with PPF, the authors evaluated the functional outcome through the functional independence measure questionnaire and the modified Merle d'Aubigne and Postel score in addition to reporting on LLD and gait pattern [15].…”

“…Nonsurgical management has been the standard of care in PPF, considering that the paediatric skeleton can remodel; however, this led to various long-term complications, including malunion, nonunion, scoliosis, and pelvic asymmetry [9][10][11][12]. Up to 30% of paediatric patients with unstable pelvic fractures suffered from limping, residual pain, low back pain, and permanent neurological damage [5,13].…”

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

“…6 Keshishyan et al 36 used custom external fixation in 12 patients, and the fixators were removed between 45 and 62 days with good outcomes in 10 of 12 patients. Zhu et al 37 reported the use of external fixation in the treatment of unstable pelvic fractures of 40 patients, and 36 were younger than 10 years (2 to 10 years old). Traction was added for 8 to 12 weeks in 22 patients who had vertically unstable AO/OTA type C fractures.…”