PELVIC INJURY IN CHILDHOOD: WHAT IS ITS CURRENT IMPORTANCE?

Abstract

Objective: The purpose of this study was to assess the importance of pelvic fractures in childhood by analyzing epidemiological characteristics and associated injuries.

Methods: This is a retrospective study performed between 2002 and 2012 at two trauma referral centers in São Paulo. We identified 25 patients aged 16 years old or younger with pelvic fracture.

Results: The main mechanism of trauma was traffic accident (80%), followed by fall from height (16%). At hospital admission, 92% had traumatic brain injury and 40% had hemodynamic instability. Besides pelvic fractures, 56% of the children had other associated injuries (genitourinary, abdominal, vascular, chest and neurological), and 79% of them required operative treatment. According to the Torode and Zieg classification, the majority of cases were types III and IV. Seventy-two percent of all pelvic fractures were treated by surgery; 52% involved external fixation and 20% involved open reduction and internal fixation.

Conclusions: The pelvic fractures in childhood can be considered a marker for injury severity, because the associated injuries usually are severe, needing operative treatment and leading to a high mortality rate (12%). Level of Evidence IV, Case Series.

Keywords: Accident prevention; Child; Fractures, bone; Pelvic Bones.

Figure 1. Trauma mechanism of pediatric pelvic fractures.

Figure 2. Classification according to Torode and Zieg. Figure also shows respective amount and percentage of cases found for each type of fracture.

Figura 3. (A) Patient admitted with pelvic ring fracture (Torode and Zieg Type IV). (B) Patient was submitted to stabilization and external fixation of the hip, besides exploratory laparotomy and colostomy, x-rays and clinical image (C).