Paediatric pelvic injuries: a retrospective epidemiological study from four level 1 trauma centers

Salášek, M; Havránek, P; Havlas, Vojtěch; Pavelka, Tomáš; Pešl, T; Stančák, Andrej; Hendrych, Jan; Džupa, Valér

doi:10.1007/s00264-021-05105-2

Cited by 5 publications

(8 citation statements)

References 37 publications

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“…Furthermore, six patients had a residual vertical migration resulting in LLD, which was < 1 cm and was tolerated by the patients. In the study by Salášek et al [ 8 ], the incidence of overall complications was 7.3%, which commonly included pelvic asymmetry, neurological deficits, nonunion, and ectopic calcification; they reported that the incidence of the complications was significantly higher with types B and C ( p = 0.0015) and surgical management ( p < 0.0001). In the systematic review by Sridharan et al [ 9 ], the most commonly occurring early complications were infection (5%), followed by hardware-related complications necessitating removal (2.9%).…”

Section: Discussionmentioning

confidence: 99%

“…According to various reports, pediatric pelvic fractures (PPFs) represent from 1.6 to 20% of patients presented with pelvic fractures [1][2][3][4]; it entails a significant concern owing to the vulnerability of the paediatric population and the possible long-term sequel [5,6]. It differs from adult pelvic injuries since the immature paediatric skeleton has inherent flexibility due to lax sacroiliac joints (SIJs) and symphysis pubis; furthermore, the cartilaginous cover acts as a shock absorber [7,8]. Hence, a child presenting with a pelvic fracture indicates a significant trauma [1].…”

Section: Introductionmentioning

confidence: 99%

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

Arafa

Khalifa

Fergany

et al. 2022

International Orthopaedics (SICOT)

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Purpose We aimed to report our early experience treating paediatric pelvic fractures (PPF) surgically, reporting on indications, outcomes, and complications. Methods Patients aged 0–15 with PPF treated surgically at a level I trauma centre were included prospectively between 2016 and 2018. Fractures were classified according to AO/OTA classification system. Functional evaluation was performed using a modification of the Majeed functional scoring system. Radiological evaluation of vertical and posterior displacement was performed according to Matta and Tornetta criteria and the method described by Keshishyan et al. for assessing pelvic rotational asymmetry. Results We included 45 patients (77.8% males and 22.2% females), with a mean age of 9.53 ± 3.63 and 19.87 ± 8.84 months of mean follow-up. The functional outcome was excellent in 42 (93.3%) patients, good in two (4.4%), and fair in one (2.2%). Radiologically, the vertical displacement improved from 5.91 ± 4.64 to 3.72 ± 2.87 mm (p-value 0.065), the posterior displacement improved from 7.87 ± 8.18 to 5.33 ± 13.4 mm (p-value 0.031), and the symphyseal diastasis improved from 9.88 ± 7.51 mm to 7.68 ± 3.18 mm (p-value 0.071). Residual pelvic asymmetry improved from 1.2 ± 0.61 to 0.8 ± 0.7 (p-value 0.001). Complications occurred in 21 (46.7%) patients, 11 (24.4%) pin tract infection, six (13.3%) limb length discrepancy, two (4.4%) prominent metals, one (2.2%) subcutaneous haematoma, one (2.2%) infected ISS. Conclusions We achieved acceptable functional and radiological outcomes after surgically treating a group of patients with PPF, which was relatively safe with minimal complications. The proper approach and fracture fixation tool should be tailored according to the fracture classification and the presence of associated injuries.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Arafa

Khalifa

Fergany

et al. 2022

International Orthopaedics (SICOT)

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“… 10 Although rarer than other fractures, pelvic fractures are disproportionately more severe injuries with the longest length of stay in hospital (6 days; SD 11 days) and a hospital charge (US$15011.61–US$40048 per patient) second only to vertebral fractures (US$28160.90–US$53992). 8 , 11 The mean age of traumatic paediatric pelvic fractures ranges between 6.8 and 15 years old, 1 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 with a median age of between 8 and 10 years old. 29 , 30 , 31 , 32 …”

Section: Discussionmentioning

confidence: 99%

“…Despite the confusion surrounding these statistics (which are affected by low patient numbers in these studies), clinicians should examine the lower abdomen, external genitalia, perineum and rectum, with key findings including open wounds, blood at the urethral meatus or vaginal introitus and scrotal bruising. Open fractures occur very rarely (1.7%) 10 . The presence of blood from a vaginal laceration in a child who has multiple pelvic fractures, disruption of the pelvic ring or a sacral injury increases the likelihood of a bladder or urethral injury in girls 68 .…”

Section: Assessmentmentioning

confidence: 99%

“…66 When the same authors conducted a prospective study (n = 140), they found a decrease sensitivity (0.69), but high specificity (0.95) and high negative predictive value (0.91). 67 Despite 10 The presence of blood from a vaginal laceration in a child who has multiple pelvic fractures, disruption of the pelvic ring or a sacral injury increases the likelihood of a bladder or urethral injury in girls. 68 This is crucial as these injuries are easily missed (more so in girls) and potentially worsened with urinary catheter insertion.…”

Section: Assessment and Examinationmentioning

confidence: 99%

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Paediatric pelvic fractures – an updated literature review

Nguyen

Drynan

Holland

2022

ANZ Journal of Surgery

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Background: Pelvic fractures in children are indicative of significant trauma. Patients will often have associated injuriessome of which require urgent intervention to prevent death and disability. Paediatric and adult pelvises respond to traumatic forces differently and distinct approaches are required for each population. Historically, pelvic fractures have been treated conservatively, but this trend is changing with a better understanding of the pelvis' inability to remodel significant deformity, as well as new techniques for operative fixation. Methods: A comprehensive search of the literature was conducted for articles published between 2000 and 2020 on paediatric pelvic fractures using medical databases including PubMed, Embase and the Cochrane Library. Results: We included 143 studies in our literature review and summarized the incidence, pathophysiology, assessment, management and complications associated with paediatric pelvic fractures. Conclusions: The rarity of paediatric pelvic fractures corresponds with a paucity of randomized clinical trials covering this topic. Trends such as the screening pelvic x-ray are derived from adult populations but are now questioned in children. Other aspects of assessment and management of these children warrant such levels of scrutiny.

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Pediatric Pelvic and Acetabular Fractures: Discerning Severity by Classification and Clinical Management

Igboechi

Purtell

Carry

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Existing classification systems may not adequately describe the injury patterns seen pelvic ring and acetabular fractures in the skeletally immature population. Pediatric patients, once stabilized, are often transferred for these injuries. We evaluated which commonly used systems correlate with clinical management in pediatric patients, including transfer patterns based on injury severity. Methods: A retrospective review of patients aged 1 to 15 treated for traumatic pelvic or acetabular fractures over a 10-year period at an academic level I Pediatric Trauma Center reviewed demographic, radiographic, and clinical data. Results: A total of 188 pediatric patients (average age 10.1 y) were included. Increasing injury severity based on classification Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA P<0.001; Young and Burgess P<0.001; Torode/Zieg P<0.001), increasing Injury Severity Score (P=0.0017), and decreasing hemoglobin levels (P=0.0144) were significantly associated with operative management. Injury characteristics did not differ between patients who were transferred versus patients who were brought in directly from the field. Air transport was significantly associated with surgical treatment, pediatric intensive care unit admission, polytrauma, and Torode/Zieg classification (P=0.036, <0.0001, 0.0297, 0.0003, respectively). Conclusions: Although not fully descriptive of skeletally immature fracture patterns, the AO/OTA and Young and Burgess classification systems adequately assess the severity of pelvic rings and injuries in pediatric patients and predict management patterns. The Torode and Zieg classification also predicts management. In a large cohort, air transport was significantly associated with surgical treatment, need for pediatric intensive care unit stay, the presence of an additional injury, and instability in the Torode and Zieg classification. These findings suggest that air transfers are being utilized to expedite advanced-level care in more severe injuries. Further studies with long-term follow-up are required to assess the clinical outcomes of both nonoperatively and operatively treated pediatric pelvic fractures and to guide both triage and treatment decisions for these rare but severe injuries. Level of Evidence: Level III

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Paediatric pelvic injuries: a retrospective epidemiological study from four level 1 trauma centers

Cited by 5 publications

References 37 publications

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

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

Paediatric pelvic fractures – an updated literature review

Pediatric Pelvic and Acetabular Fractures: Discerning Severity by Classification and Clinical Management

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