Traumatic pelvic fractures in children and adolescents

DeFrancesco, Christopher J.; Sankar, Wudbhav N.

doi:10.1053/j.sempedsurg.2017.01.006

Cited by 32 publications

(60 citation statements)

References 27 publications

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“…The findings by Smith et al [ 14 ] suggested that in contrast to the previous belief that pelvic fractures in children would eventually remodel; pelvic asymmetry either persisted or increased with time. Currently, there is overall consensus in the literature that unstable pelvic fractures in children require operative intervention [ 1 – 3 , 5 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…This mechanism of injury is not uncommon, but the fact that a tractor was involved contributed to the severity of the injury. The majority of pelvic fracture in children occur due to pedestrian motor vehicle accidents (MVA), followed by passenger MVA; other reported modes of injury include falls, sport injuries, bicycle injuries and driveway injuries [ 2 , 3 , 7 ]. Additionally, Shaath et al [ 12 ] found that children with open triradiate cartilage are more likely to suffer from injuries due to pedestrian MVA, which results in lateral compression-type injuries, while children with open triradiate cartilage are more likely to suffer from passenger MVA, which mimics antero-posterior compression-type injuries.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, an apparently benign pelvic injury may conceal a much more serious blunt abdominal or soft tissue injury due to the relative resilience of the bony structure in children. Furthermore, injury to the growth centers may alter the long-term outcomes of these injuries [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Hemodynamically unstable patients with unstable anterior and posterior pelvic ring injuries are usually managed acutely. Management consists of pelvic binder application, external fixation, pelvic packing or angiography [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Open complete anterior dislocation of the sacro-iliac joint in a 4-year-old boy: a case report of a rare injury with 5-year follow-up

Elnahal¹,

Fahmy²,

Acharya³

2017

Strategies in Trauma and Limb Reconstruction

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Pelvic fractures are uncommon in children and account for between 0.3 and 7.5% of all pediatric injuries. Open pelvic fractures only account for up to 12.9% of all pediatric pelvic fractures. An unusual case of open complete anterior sacro-iliac joint dislocation in a 4-year-old boy is presented with a long-term follow-up. The multidisciplinary approach is reported with review of the current literature. A 4-year-old male presented to our institution in January 2012 after having been run over by a tractor. He presented with gross hemodynamical instability, MISS of 25, and an unstable lateral compression type III pelvic fracture with complete anterior dislocation of the left hemipelvis and a groin wound extending into the left thigh. The patient was managed in accordance with the ATLS and open fracture guidelines. Reduction in the dislocated SI joint was achieved via a posterior approach to the SI joint, followed by fixation with 2K wires in S1 and S2 sacral segments, with an anterior external fixator. Pelvic asymmetry post-reduction was 0.9 cm, compared to 16 cm post-injury, and asymmetry persisted till final follow-up at 5 years. At 5 years, patient regained full function, including recreational sport activities. Patients scored a 96/96 on the Majeed score (after excluding 4 points for sexual function). We believe that posterior reduction in an anteriorly dislocated SI joint in the pediatric population is a viable option. A coordinated, multidisciplinary approach and restoration of pelvic ring stability can lead to optimal outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Open complete anterior dislocation of the sacro-iliac joint in a 4-year-old boy: a case report of a rare injury with 5-year follow-up

Elnahal¹,

Fahmy²,

Acharya³

2017

Strategies in Trauma and Limb Reconstruction

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“…Although the incidence of pelvic fractures in children is low, associated mortality rates are reportedly as high as 25% [5][6][7]. The cause of death in children with pelvic fractures is mainly due to combined injuries, and not the fracture itself [8].…”

Section: Introductionmentioning

confidence: 99%

The application of lateral-rectus approach on toddlers’ unstable pelvic fractures

Liu

Zhan

Huang

et al. 2020

BMC Musculoskelet Disord

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Background: Pelvic fractures are rare in toddlers but are often associated with other injuries that make treatment difficult. Conservative treatment has been used with moderate success, but it is unclear if surgical correction could confer additional benefits and improve patient outcomes. The purpose of this study was to report authors' experience using the lateral-rectus approach (LRA) for surgical correction of unstable pelvic fractures in two toddlers. Methods: We retrospectively analyzed the cases of two toddlers with unstable pelvic fractures who underwent surgery through the LRA between April 2016 and October 2018. Patients' characteristics, fracture type, mechanism of injury, Injury Severity Score (ISS), operative time, intra-operative blood loss, and post-operative complications were assessed. Pelvic asymmetry, degree of deformity, Cole scoring criteria and modified Barthel Index (MBI) were used to evaluate radiographic and functional outcomes. Results: Successful surgical treatment was performed using the LRA, external fixation, and sacroiliac screw fixation. Surgery duration was 180 min on average, with an average intra-operative bleeding of 250 ml. There were no iatrogenic nerve injuries or infections. Pelvic asymmetry a week after surgery was 0.5 cm on average and dropped to 0.3 cm on average at the end of the follow-up period. The deformity index of the pelvis dropped from an average of 0.035 a week after surgery to 0.02 at the end of the follow-up period. The mean MBI was 100 in the last follow-up, and Cole scoring criteria categorized both patients as being in excellent condition. All patients achieved radiological bone union without discrepancy in length of the lower limbs. Neither patient had loss of reduction nor evidence of low back pain during the mean follow-up period of 22 months. Conclusions: Pelvic fracture in toddlers is rare, and surgical treatment requires careful consideration. The lateral-rectus approach was proven as a viable alternative for managing unstable pelvic fractures in toddlers, with minimal blood loss and risk of nerve injury. Furthermore, anterior external fixation and posterior sacroiliac screw fixation would be adequate for this population, with excellent final outcome.

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