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Early functional outcome in children with pelvic fractures
J S Upperman1, M Gardner, B Gaines
1Department of Surgery, Children's Hospital of Pittsburgh, Pennsylvania 15213, USA.
Insights
Children with pelvic fractures often experience significant short-term functional impairment, regardless of fracture stability. Early, aggressive rehabilitation is crucial for optimizing functional outcomes in pediatric pelvic fracture patients.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Rehabilitation Medicine
Background:
- Pelvic fractures in children are associated with significant mortality and morbidity.
- Functional outcomes in pediatric pelvic fracture patients remain understudied.
- Understanding functional independence is key to optimizing management protocols.
Purpose of the Study:
- To retrospectively analyze functional independence measurement (FIM) at discharge in children with pelvic fractures.
- To determine the impact of pelvic fracture type on functional outcomes.
- To inform management protocols for pediatric pelvic fracture patients.
Main Methods:
- Retrospective review of pediatric pelvic fracture cases (1993-1998) from a level I pediatric trauma center registry.
- Stratification of patients by demographics, fracture type (stable vs. unstable), FIM scores, and discharge disposition.
- Fracture classification: Grades 1-3 as stable, Grade 4 as unstable.
Main Results:
- 88 children with pelvic fractures were analyzed; 74% had stable, 26% unstable fractures.
- Motor vehicle crashes were the primary cause of injury.
- Significant functional dependence in locomotion and transfers was observed in both stable (52%) and unstable (80%) fracture groups.
Conclusions:
- A high percentage of children with pelvic fractures exhibit impaired short-term function.
- Early and aggressive rehabilitation is recommended for all pediatric pelvic fracture patients.
- Optimizing functional outcomes requires prompt initiation of rehabilitation interventions.
Background/Purpose:
Although the mortality, morbidity, and spectrum of associated injuries in children with pelvic fractures have been extensively studied, little is known about the functional outcomes in these patients. The authors examined retrospectively functional independence measurement (FIM) at discharge in children with pelvic fractures to determine how it should influence their management protocol.
Methods:
The authors reviewed the records of all patients who sustained pelvic fractures between 1993 and 1998 in the trauma registry of a level I pediatric trauma center. Patients were stratified according to demographics, type of pelvic fracture, functional independence measurement, and discharge disposition. Fractures graded 1, 2, or 3 were defined as stable, whereas grade 4 fractures were deemed unstable.
Results:
A total of 88 children sustained pelvic fractures. Seventy-four percent had stable fractures, whereas 26% sustained unstable fractures. There was no difference in age or sex between the groups; boys were more commonly injured than girls. Motor vehicle-related crashes accounted for most injuries. The mean injury severity score (ISS) for patients with a stable fracture was 17 +/- 14 and 20 +/- 13 for unstable fractures. There was no difference in overall hospitalization nor intensive care unit stay between the unstable and stable fracture patients. Eighty percent of the patients with unstable and 52% of the patients with stable pelvic fractures were dependent based on locomotion, and similar proportions were seen for the transfer category.
Conclusions:
Short-term function appears to be significantly impaired in a high percentage of children with stable and unstable pelvic fractures. Therefore, aggressive rehabilitation should be instituted early in all children with pelvic fractures to achieve optimal functional outcome.
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