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. 2015 Jul 31:9:303-12.
doi: 10.2174/1874325001509010303. eCollection 2015.

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

Theodoros H Tosounidis  1 , Hassaan Sheikh  1 , Peter V Giannoudis  1
Affiliations

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

Theodoros H Tosounidis et al. Open Orthop J. .

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.

Keywords: Children; mortality; pelvic fracture; polytrauma.

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Figures

Fig. (1)
Fig. (1)
Preoperative Anteroposterior pelvic radiograph (a), axial (b) and coronal (c) CT scans demonstrating a type C injury of the left hemipelvis, equivalent to Lateral Compression type II injury (crescent fracture) in a 10-year-old boy.
Fig. (2)
Fig. (2)
Intraoperative photographs showing the fracture of the left iliac wing before (a) and after (b) the application of the two reconstruction plates. The patient’s head is on the right. The circles on the bottom of the screen represent the PSIS and the lateral transverse process of L5. Note the curvilinear incision for the approach to the iliac wing.
Fig. (3)
Fig. (3)
Anteroposterior (a), inlet (b) and outlet (c) radiographs of the same patient at four months postoperatively.
See this image and copyright information in PMC

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