Long-term results of unstable pelvic ring fractures in children

Schwarz, N.; Posch, E.; Mayr, Johannes; Fischmeister, F.M.; Schwarz, Angelika; Öhner, Thomas

doi:10.1016/s0020-1383(98)00074-6

Cited by 70 publications

(42 citation statements)

References 3 publications

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“…Symphyseal and sacroiliac disruptions may also be treated in a closed manner secondary to children's greater potential for periosteal healing and bone remodelling. 2,27,28 The percentage of TRC patients treated with operative fixation for a pelvic injury in our study, 25.4%, is similar to that of adults at 28.1%. 29 In their series, Silber et al reported that all patients requiring operative fixation of pelvic fractures had a closed triradate cartilage.…”

Section: Discussionsupporting

confidence: 54%

Analysis of pelvic fracture pattern and overall orthopaedic injury burden in children sustaining pelvic fractures based on skeletal maturity

Shaath¹,

Koury²,

Gibson³

et al. 2017

J Child Orthop

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Purpose The purpose of this study was to review pelvic fractures and concomitant orthopaedic injuries in children who have a patent triradiate cartilage (TRO) compared with children whose triradiate cartilage has closed (TRC). We hypothesise that these injuries will differ, leading to correlated alterations in management.Patients and Methods Using a database, we retrospectively reviewed patients aged below 18 years with pelvic fractures presenting to our Level 1 trauma center. Radiographs and CT scans were reviewed to identify orthopaedic injuries and categorise pelvic injuries using the modified Torode classification between the two groups.Results A total of 178 patients met inclusion criteria (60 TRO and 118 TRC). Mean age ± SD for TRO and TRC groups were 8 ± 4 years and 16 ± 2 years, respectively. TRO patients were more likely to present as a pedestrian struck by a vehicle (odds ratio (OR) 6.0; p < 0.001) and less likely to present after a motor vehicle collision (OR 0.2; p < 0.001). TRO patients were more likely to sustain rami fractures (OR 2.1; p = 0.020) and Torode IIIA injuries (OR 3.6; p < 0.001). They were less likely to sustain acetabular fractures (OR 0.5; p = 0.042), sacral fractures (OR 0.4; p = 0.009), hip dislocations (p = 0.002) and Torode IV injuries (OR 0.4; p = 0.004). TRO patients were less likely to be treated operatively for their pelvic (OR 0.3; p = 0.013) and orthopaedic injuries (OR 0.4; p = 0.006). ConclusionWe suggest that patients with open triradiate cartilage are unique. Their pelvic injuries may be treated more conservatively as they have a greater potential for periosteal healing and bone remodelling. Patients with closed triradiate cartilage should be treated similarly to adults, as they share a similar mechanism of injury and need for operative fixation.

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Section: Discussionsupporting

confidence: 54%

Analysis of pelvic fracture pattern and overall orthopaedic injury burden in children sustaining pelvic fractures based on skeletal maturity

Shaath¹,

Koury²,

Gibson³

et al. 2017

J Child Orthop

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“…Schwarz et al (16) , relatam 47% de maus resultados devido à assimetria pélvica, e enfatiza a importância de se obter uma redução anatômica e conclui que fraturas instáveis do anel pélvico tratadas conservadoramente evoluem com resultado funcional inaceitável. Outros autores (3,13,17) apresentam casos de fraturas instáveis do anel pélvico tratados não cirurgicamente que evoluíram com resultado insatisfatório, com dor residual na região posterior da bacia, discrepância de membros inferiores, sinal de Trendelenburg e escoliose lombar devido à assimetria pélvica residual.…”

Section: Discussionunclassified

Tratamento cirúrgico da fratura instável do anel pélvico em pacientes esqueleticamente imaturos

Guimarães¹,

Meirelles²,

Júnior³

et al. 2010

Rev. bras. ortop.

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“…Especially young children are predisposed to upper cervical spine injuries facilitated by a high head to body ratio and horizontal facet orientation. 3,6 Moreover, the vertebral bodies are wedge shaped, ligaments are elastic, stabilizing muscles are weak and complex sensomotor coordination is slow. 4,7 The here additionally observed fracture of the odontoid process represents one of the most common cervical injury in pediatric patients.…”

Section: Mechanism Of Injurymentioning

confidence: 99%

Brook’s Wiring for Treatment of an Atlanto-Axial Dislocation and Odontoid Fracture in a Child

Schicho¹

2015

MOJCR

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IntroductionCervical spine injuries are rarely seen in children with an overall incidence of about 1-1.5%. 1,2 In pediatric cervical spine injury, the upper cervical spine is the most common site affected (52% of cases). 2The typical injury mechanisms for pediatric cervical spine injuries are hyper flexion movements as in motor vehicle accidents, because of distinct anatomic properties of a child's body, like an increased head-to-body ratio. 3,4 We here report the case of a 5-year-old boy, who sustained a severe hyperflexion trauma of the cervical spine in a highspeed car accident (approx. 60 mph). Computed tomography (CT) and magnetic resonance imaging (MRI) showed a complete atlanto-axial dislocation with synchondrotic fracture of the odontoid process. Case historyIn February 2013, a 5-year-old boy was a restrained passenger in a high-speed car crash with presumed high-force impact. Neither initial nor delayed unconsciousness were reported. He was responsive on scene, with neck pain and loss of head rotation. He was immobilized with stiff neck and spine-board and admitted to the emergency department of our hospital. DiagnosisExamination showed a glascow coma score (GCS) of 15 with pupils equal, round, reactive to light and accommodation. He was responsive and alert on scene but couldn't remember what has happened. The primary survey showed no disabilities or signs of head, chest, abdominal, pelvic or extremity injury. Both loss of head rotation and neck pain persisted. No abdominal damage aroused from sonographic assessment. We decided to perform a computed tomography (CT) of his head and neck to rule out intracerebral bleeding and fractures. Standard and 3D reconstructions revealed an atlanto-axial dislocation with a displacement of the atlas >5mm, a fracture of the odontoid process with a ventral axis tilt of 22° (Figure 1) and no signs of intracerebral bleeding. A following MRI scan Figure 2 showed ruptures of the interspinous ligaments from C2 to C6 with intact alar ligaments. The spinal cord showed no signs of damage. These findings lead to the diagnosis of an atlanto-axialdislocation with synchondrotic fracture of the odontoid process in a neurologically intact 5-year-old boy. AbstractBackground: Upper cervical spine injuries are rarely seen in children. Distinct anatomic properties make head and neck susceptible to hyperflexion movements.

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Long-term results of unstable pelvic ring fractures in children

Cited by 70 publications

References 3 publications

Analysis of pelvic fracture pattern and overall orthopaedic injury burden in children sustaining pelvic fractures based on skeletal maturity

Analysis of pelvic fracture pattern and overall orthopaedic injury burden in children sustaining pelvic fractures based on skeletal maturity

Tratamento cirúrgico da fratura instável do anel pélvico em pacientes esqueleticamente imaturos

Brook’s Wiring for Treatment of an Atlanto-Axial Dislocation and Odontoid Fracture in a Child

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