Pelvic Fractures in Children Results from the German Pelvic Trauma Registry: A Cohort Study

Abstract

As pelvic fractures in children and adolescents are very rare, the surgical management is not well delineated nor are the postoperative complications. The aim of this study using the prospective data from German Pelvic Trauma Registry study was to evaluate the various treatment approaches compared to adults and delineated the differences in postoperative complications after pelvic injuries.Using the prospective pelvic trauma registry established by the German Society of Traumatology and the German Section of the Arbeitsgemeinschaft für Osteosynthesefragen (AO), International in 1991, patients with pelvic fractures over a 12-year time frame submitted by any 1 of the 23 member level I trauma centers were reviewed.We identified a total of 13,525 patients including pelvic fractures in 13,317 adults and 208 children aged ≤14 years and compared these 2 groups. The 2 groups' Injury Severitiy Score (ISS) did not differ statistically. Lethality in the pediatric group was 6.3%, not statistically different from the adults' 4.6%. In all, 18.3% of the pediatric pelvic fractures were treated surgically as compared to 22.7% in the adult group. No child suffered any thrombosis/embolism, acute respiratory distress syndrome (ARDS), multiorgan failure (MOF), or neurologic deficit, nor was any septic MOF detected. The differences between adults and children were statistically significant in that the children suffered less frequently from thrombosis/embolism (P = 0.041) and ARDS and MOF (P = 0.006).This prospective multicenter study addressing patients with pelvic fractures reveals that the risk for a thrombosis/embolism, ARDS, and MOF is significant lower in pediatric patients than in adults. No statistical differences could be found in the ratios of operative therapy of the pelvic fractures in children compared to adults.

FIGURE 1

Development of mean age of the pediatric and adult groups since 1991. Mean age in the pediatric group was 9.3 years (±4.2) with a mean Injury Severitiy Score (ISS) of 16.7 (±15) points. Mean age in the adult group was 53.5 years (±23.5) with a mean ISS of 15 (±15) points (ISS: P > 0.05). The adults’ mean age rose over time (mean age: 48, 53, and 59 years) (P < 0.001), whereas we observed no statistical difference in the children's mean age overtime (P > 0.05).

FIGURE 2

Development of the gender ratio of children and adults. We conducted a further analysis of the gender ratio of these patients, which revealed a continuous trend in the group of adults, namely a significantly decreasing gender ratio with a nearly equal ratio of 1.03 in the latest investigation period (P < 0.001). However, in the pediatric group, many more boys suffered pelvic fractures, at a ratio of 1.48 from 2004 to 2012 with an overall rate of 58% boys and 42% girls; there was no statistical difference in the gender ratio in the pediatric group's 3 time periods (P > 0.05).

FIGURE 3

The ratio of an operative therapy of children and adults. In Figure 3 illustrates the ratios of operative therapy of the pelvic fractures. A total of 18.3% of the pediatric pelvic fractures were treated operatively, while 22.7% of the adults’ fractures were treated surgically. The other patients were treated conservatively; we detected no statistical difference between the adults and children in therapy terms (P > 0.05). What is remarkable is that in the very 1st time period, very few children underwent surgery compared to the adults. However, from the second time period, the rate of operative therapy is similar in both groups.

FIGURE 4

Clinical follow-up after pelvic fracture. Clinical follow-up is shown in Figure 4 and is based on data from 10 children (most from examinations in our clinic) 3.3 (±0.9) years after trauma and from available data in the registry of 631 adults who had undergone follow-up 2.5 (±1.7) years after trauma. The EQ5D score represents quality of life and the Merle d’Aubigne Score represents patient functionality. The 10 analyzed children had significantly better results in the follow-up investigations according to both scores (P < 0.05).