Abstract
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 2nd 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.
