Analysis of pelvic fracture pattern and overall orthopaedic injury burden in children sustaining pelvic fractures based on skeletal maturity

Abstract

Purpose: The purpose of this study was to review pelvic fractures and concomitant orthopaedic injuries in children who have a patent triradiate cartilage (TRO) compared with children whose triradiate cartilage has closed (TRC). We hypothesise that these injuries will differ, leading to correlated alterations in management.

Patients and methods: Using a database, we retrospectively reviewed patients aged below 18 years with pelvic fractures presenting to our Level 1 trauma center. Radiographs and CT scans were reviewed to identify orthopaedic injuries and categorise pelvic injuries using the modified Torode classification between the two groups.

Results: A total of 178 patients met inclusion criteria (60 TRO and 118 TRC). Mean age ± SD for TRO and TRC groups were 8 ± 4 years and 16 ± 2 years, respectively. TRO patients were more likely to present as a pedestrian struck by a vehicle (odds ratio (OR) 6.0; p < 0.001) and less likely to present after a motor vehicle collision (OR 0.2; p < 0.001). TRO patients were more likely to sustain rami fractures (OR 2.1; p = 0.020) and Torode IIIA injuries (OR 3.6; p < 0.001). They were less likely to sustain acetabular fractures (OR 0.5; p = 0.042), sacral fractures (OR 0.4; p = 0.009), hip dislocations (p = 0.002) and Torode IV injuries (OR 0.4; p = 0.004). TRO patients were less likely to be treated operatively for their pelvic (OR 0.3; p = 0.013) and orthopaedic injuries (OR 0.4; p = 0.006).

Conclusion: We suggest that patients with open triradiate cartilage are unique. Their pelvic injuries may be treated more conservatively as they have a greater potential for periosteal healing and bone remodelling. Patients with closed triradiate cartilage should be treated similarly to adults, as they share a similar mechanism of injury and need for operative fixation.

Keywords: Fracture; Injury Burden; Multitrauma; Pelvic Fracture.

Fig. 1.

Operative pelvic procedures in the TRC group.

Fig. 2

(a) Injury film. There are fractures of the left inferior and superior rami and the left pubic bone. There is also widening of the left triradiate cartilage. (b) One month: there is callus about the rami fractures and the medial margin of the triradiate cartilage. (c) Three months: there is continued healing of the bilateral rami fractures with bridging callus across the proximal margin of the pubic symphysis. There is a focus of heterotopic ossification adjacent to the right ischial tuberosity. (d) Ten months: there is continued ossification across the pubic symphysis and the left rami fractures. There is bone bridging across the medial margin of the left triradiate cartilage. (e) Three years: all fractures have healed and there is ossification across the pubic symphysis and rami fractures. There is also bone across the left obturator foramen. There is bridging bone across the left triradiate cartilage.

Fig. 3.

(a) Fractures of the left acetabulum with medial displacement of the wall. There are fractures of the left pubis and superior/inferior rami. (b) Status post-operative fixation. (c) Three months status post-operative fixation, fractures are healed with heterotopic ossification on the left side.