Pelvic Fractures in Paediatric Polytrauma Patients: Classification, Concomitant Injuries and Early Mortality

Abstract

Purpose of this Study : To review the characteristics, concomitant injuries and mortality in children with polytrauma and associated pelvic fractures treated in a Level-I Trauma Centre.Materials and Methods : Between December 2003 and November 2013, 49 children with an Injury Severity Score (ISS) of 16 or greater and a pelvic fracture met the inclusion criteria and were evaluated. The mortality, transfusion requirements and length of intensive care unit stay were correlated with the ISS, Abbreviated Injury Scale, concomitant limb and spine fractures, and type of pelvic ring injury (AO/OTA classification).Results : The mean ISS at presentation was 31.4 (range 16 to 57). 19 (38.7%) patients sustained a Type A, 27 (55.1%) a Type B and 3 (6.2%) a Type C injury. Head and face trauma was present in 33 (67.3%) cases. Blood transfusion during the resuscitation process was necessitated in six (12.2%) patients. Thirty-eight (77.5%) patients were managed non-operatively for their pelvic injuries. The mean duration of hospital stay was 23.9 days (range 1 to 146 days). In this cohort of polytrauma paediatric patients there were five (10.2%) mortalities (all suffered an associated head trauma ) within 30 days from the initial injury.Conclusion: Severe head injury and a high ISS are significantly associated with mortality in children with pelvic fractures. These patients have a high incidence of concomitant spine and chest injuries Hemorrhage due to pelvic injuries is rare. Severe head injuries predict a longer ICU stay in this population.

Clinical characteristics, injury pattern and management of pediatric pelvic fracture: An observational retrospective study from a level I trauma center

“…On the other hand, femoral and tibia fractures were the most common associated fractures in the limbs. In contrast, spine fracture, mainly thoracic spine, was the most common associated fracture in the axial skeleton [3,5,19] which is similar to our findings. The 24-h mortality for pediatrics polytrauma patients is related to many factors, including the injury severity score; patients associated with higher ISS scores were hemodynamically unstable and required blood transfusion.…”

“…On the other hand, femoral and tibia fractures were the most common associated fractures in the limbs. In contrast, spine fracture, mainly thoracic spine, was the most common associated fracture in the axial skeleton [ 3 , 5 , 19 ] which is similar to our findings.…”

“…The high-energy trauma includes MVC, pedestrian hit by a car and falling from height results in pelvic fracture of immature bone in children and is an indicator of the presence of associated injuries [ 18 , 19 ]. The present study observed traffic accidents as the most common mechanism of injury which is similar to that of the adult pelvic fracture patients [ 20 ]; a finding that was reported by several earlier studies [ 4 , 9 , 10 , 18 , 19 ].…”

“…In our study the overall mortality is 2.5% and two out of three patients died due to concomitant head injury. Notably, the severity of pelvic ring injury was not associated with early mortality [ 12 , 19 , 24 , 25 ]. The increase in the mortality rate among adult polytrauma patients has been correlated with increased patient age, while this correlation was not observed in pediatrics polytrauma patients [ 12 ].…”

Management of Orthopaedic Injuries in Multiply Injured Child

“…Pelvic fractures result from high energy trauma and often associated with trauma to limbs, chest, spine, abdomen, and head. 74 75 76 Unlike adults, pelvic trauma is not a cause of mortality in multitrauma children. However, associated head and visceral injuries can prove fatal.…”