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Paediatric pelvic fractures: how do they differ from adults?

View Article: PubMed Central - PubMed

ABSTRACT

Background: The aim of this article was to review the incidence, presentation, treatment and complications of paediatric pelvic fractures of children who were admitted to our level 1 trauma centre and to compare them with our data from adult pelvic fracture patients.

Methods: We conducted a retrospective chart review of all children with pelvic fractures who were managed at our institution between January 1993 and December 2013 and compared the data with our database on pelvic fractures in adults during the period 2007 to 2012.

Results: We identified 51 children and 268 adults with pelvic fractures. The median age of the paediatric patients was 11 years. Children were significantly more involved in traffic accidents than adults (p < 0.001). Adults had a significantly higher Injury Severity Score (ISS) (31 vs 24.5; p < 0.03) and were significantly more often haemodynamically unstable (p < 0.01). Adults had a type C fracture more often, while children had a type B fracture (p < 0.001). Associated injuries were seen in both groups; however, thoracic injuries were significantly higher in adults (p < 0.01) and injuries to the extremities were higher in children (p < 0.01). Adults were significantly more often treated with open reduction and internal fixation (p < 0.001). Mortality in both groups, however, did not differ (6% vs 8%).

Conclusion: Paediatric pelvic fractures are rare. They differ from adult pelvic fractures in presentation, associated injuries and management. Mortality, however, is substantial and does not differ from the adult population. Mortality is often due to concomitant injuries and not to exsanguination from the pelvic fracture.

No MeSH data available.


Related in: MedlinePlus

Pelvic radiograph one year after injury: uncomplicated fracture healing, removal of hardware, non-operatively treated anterior pelvic ring shows re-alignment. At follow-up after two years, the patient had a normal gait and was able to enjoy soccer and jazz ballet.
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Figure 4: Pelvic radiograph one year after injury: uncomplicated fracture healing, removal of hardware, non-operatively treated anterior pelvic ring shows re-alignment. At follow-up after two years, the patient had a normal gait and was able to enjoy soccer and jazz ballet.

Mentions: Three patients had an open pelvic fracture as a result of skin lacerations, degloving or wounds from burns. Antibiotics were prescribed for all of these patients. One patient had a ruptured rectum and another had a ruptured bladder and a retroperitoneal hematoma. In all cases of uro-logical damage, the Urology Department was consulted for advice on treatment. Five other patients with urethral injury were initially primarily managed with a transurethral catheter; of these, two were managed with secondary reconstruction in the operating room at a later time by a paediatric urologist. Seven patients with a pelvic fracture sustained an additional acetabular fracture which, due to minimal displacement, were all managed non-operatively. Figures 2 to 4 demonstrate a pelvic fracture in a 12 year old patient, operative treatment and one year later with fracture healing.


Paediatric pelvic fractures: how do they differ from adults?
Pelvic radiograph one year after injury: uncomplicated fracture healing, removal of hardware, non-operatively treated anterior pelvic ring shows re-alignment. At follow-up after two years, the patient had a normal gait and was able to enjoy soccer and jazz ballet.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5382336&req=5

Figure 4: Pelvic radiograph one year after injury: uncomplicated fracture healing, removal of hardware, non-operatively treated anterior pelvic ring shows re-alignment. At follow-up after two years, the patient had a normal gait and was able to enjoy soccer and jazz ballet.
Mentions: Three patients had an open pelvic fracture as a result of skin lacerations, degloving or wounds from burns. Antibiotics were prescribed for all of these patients. One patient had a ruptured rectum and another had a ruptured bladder and a retroperitoneal hematoma. In all cases of uro-logical damage, the Urology Department was consulted for advice on treatment. Five other patients with urethral injury were initially primarily managed with a transurethral catheter; of these, two were managed with secondary reconstruction in the operating room at a later time by a paediatric urologist. Seven patients with a pelvic fracture sustained an additional acetabular fracture which, due to minimal displacement, were all managed non-operatively. Figures 2 to 4 demonstrate a pelvic fracture in a 12 year old patient, operative treatment and one year later with fracture healing.

View Article: PubMed Central - PubMed

ABSTRACT

Background: The aim of this article was to review the incidence, presentation, treatment and complications of paediatric pelvic fractures of children who were admitted to our level 1 trauma centre and to compare them with our data from adult pelvic fracture patients.

Methods: We conducted a retrospective chart review of all children with pelvic fractures who were managed at our institution between January 1993 and December 2013 and compared the data with our database on pelvic fractures in adults during the period 2007 to 2012.

Results: We identified 51 children and 268 adults with pelvic fractures. The median age of the paediatric patients was 11 years. Children were significantly more involved in traffic accidents than adults (p < 0.001). Adults had a significantly higher Injury Severity Score (ISS) (31 vs 24.5; p < 0.03) and were significantly more often haemodynamically unstable (p < 0.01). Adults had a type C fracture more often, while children had a type B fracture (p < 0.001). Associated injuries were seen in both groups; however, thoracic injuries were significantly higher in adults (p < 0.01) and injuries to the extremities were higher in children (p < 0.01). Adults were significantly more often treated with open reduction and internal fixation (p < 0.001). Mortality in both groups, however, did not differ (6% vs 8%).

Conclusion: Paediatric pelvic fractures are rare. They differ from adult pelvic fractures in presentation, associated injuries and management. Mortality, however, is substantial and does not differ from the adult population. Mortality is often due to concomitant injuries and not to exsanguination from the pelvic fracture.

No MeSH data available.


Related in: MedlinePlus