Aims

Paediatric pelvic ring fractures are rare but severe injuries, presenting significant treatment challenges. This study aimed to analyze patient characteristics and explore trends in incidence, treatment methods, and mortality associated with these injuries.

The October 2015 Trauma Roundup³⁶⁰ looks at: PCA not the best in resuscitation; Impact of trauma centre care; Quality of life after a hip fracture; Recovery and severity of injury: open tibial fractures in the spotlight; Assessment of the triplane fractures; Signs of an unstable paediatric pelvis; Safe insertion of SI screws: are two views required?; Post-operative delirium under the spotlight; Psychological effects of fractures; K-wires cost effective in DRAFFT

Pelvic fractures in children are rare and potentially disastrous injuries. Using medical records and radiographs over a three year period from January 2008 to March 2011 at an academic hospital we retrospectively analysed the incidence, the associated data and management of these injuries. Results. During this time period 633 paediatric patients where admitted with trauma related injuries; only 19 had pelvic fractures, an incidence of 0.03%. The majority of these patients (13) were involved in PVA's; while MVA (3), fall from height (1) and sports injuries (1) made up the rest. Males (13) were injured more commonly and the average age of the patients was 9 years (3–14). There is debate of over the ideal paediatric pelvic fracture classification system in the literature. However, 13 pelvic fractures were classified stable; 3 were unstable fractures with disruption of the pelvic ring. In addition 2 iliac wing fractures and 1 avulsion (apophyseal) fracture were found. 58% of the patients had associated injuries, however, only 2 of the 19 had associated abdominal viscus injuries. Neither of these required exploratory laparotomy and were managed conservatively. The treatment of these pelvic fractures in our unit was patient specific and largely conservative. 17 patients' pelvic fractures were treated with bed rest, analgesia and mobilisation as pain allowed while the remaining 2 had pelvic external fixators. No ORIF's were performed. Associated orthopaedic injuries were managed accordingly. The average hospital stay of a patient with a pelvic fracture was 15 days (3–48 days). There were no mortalities during this time period

Introduction. Trauma is the leading cause of death and disability in children. Pelvic fractures although rare, with a reported incidence of one per 100,000 children per year are 2. nd. only to skull fractures with respect to morbidity. The objectives of this study were to improve understanding of paediatric pelvic fractures through a concise review of all aspects of these fractures and associated injuries. Understanding the patterns in which paediatric pelvic fractures and their associated injuries occur and the outcome of treatment is vital to the establishment of effective preventative, diagnostic and therapeutic interventions. Patients and Methods. All children admitted to our unit with a pelvic fracture over the 14-year period from January 1995 to December 2008 were identified. The complete medical records and radiographs of all patients were obtained and reviewed. Data recorded included, age, sex, mechanism of injury, Glasgow Coma Score, Injury Severity Score, fracture type, radiological investigation, length of in-patient stay, length of intensive care unit stay, blood transfusion requirement, associated injuries, management (both orthopaedic and non-orthopaedic), length of follow-up, and outcome. Results. Over the study period thirty-nine children with a pelvic fracture were treated at our institute. The patients ranged in age from 1 to 14 years with a mean age of 8.6. The mean Glasgow coma score at presentation was 13.25 (range 3-15). The mean Injury Severity Score (ISS) was 17.1 (range 4-75). The most common mechanism of injury was a pedestrian being struck by a motor vehicle. A pelvic fracture was evident on the initial plain radiographs of all 39 children. Further radiographic investigation (12 CT's and 1 MRI) of the pelvic injury were undertaken in 13 (33%) of the children. Additional posterior ring fractures were identified in 9. The majority of children (18/39, 46%) sustained a Torode and Zeig type 3 fracture. A total of 32 children (82%) sustained one or more associated injuries. Head injuries accounted for 25% of these. Associated orthopaedic/skeletal injuries consisted of 22 fractures in 18 children accounting for 33% of all associated injuries. Fourteen children required a total of 24 acute surgical procedures, these were divided into orthopadic (n=12) and non-orthopaedic (n=12). The orthopaedic management of the pelvic fracture was non-operative in 37 (94%) of the children. Mean out-pateint clinical follow-up was for 27 months (range 3-85). There was one mortality in this series. Eight children (20%) suffered long term sequale. Conclusion. Pediatric pelvic fractures differ from their adult counterpart in etiology, fracture type, and associated injury pattern. They represent a reliable marker for severe trauma and associated injuries should be sought out in all cases. Injury to other organ systems should prompt early evaluation by the appropriate specialists. Optimal treatment guidelines for paediatric pelvic fractures are not yet fully defined but would seem to favour the management of more skeletally mature adolescents by the same principles used in the adult population

Introduction: Paediatric Pelvic fractures are rare and constitute only 1% to 3% of all fractures in children; they are different from other fractures in children due to concomitant injuries that occur immediately. Method: A retrospective analysis was performed in order to review the pattern of paediatric pelvic fractures, indications for surgical treatment and outcome of pelvic fractures in children. In our study we included paediatric patients with significant pelvic fractures, who were treated surgically between 1992 and 2004. We excluded tendon-bone avulsion injuries and acetabular fractures from study. Results: We treated 29 paediatric pelvic fractures in this duration. Mean age was 14.17 (5 to 17) years. All of these patients had procedure under general anaesthetic under care of single consultant. 10 had ORIF of pelvis, 13 had external fixator application, 5 had sacral screw fixation and 6 had examination under anaesthesia. We shall discuss the results in detail in presentation. Discussion: We concluded that although pelvic fractures in children are uncommon but require early diagnosis and management and this should not differ greatly from those in adults