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Changing patterns of pediatric pelvic fractures with skeletal maturation: implications for classification and
1Long Island Jewish Medical Center, New Hyde Park, New York, USA. jeffsilber2000@yahoo.com
Insights
Pediatric pelvic fractures differ based on skeletal maturity. Immature pelvises often present with pubic rami fractures, while mature pelvises show acetabular fractures and diastasis, requiring different management strategies.
Area of Science:
- Orthopaedic surgery
- Pediatric traumatology
- Skeletal maturation
Background:
- Pediatric pelvic fractures exhibit unique patterns.
- Current classifications may not account for skeletal maturity.
- Understanding age-related changes is crucial for appropriate management.
Purpose of the Study:
- To determine how pelvic fracture patterns and management evolve with skeletal maturity.
- To differentiate fracture characteristics between immature and mature pediatric pelves.
Main Methods:
- Retrospective review of 166 pediatric pelvic fractures.
- Radiographic assessment of triradiate cartilage physes (open, narrowed, closed).
- Evaluation of Risser sign, fracture patterns, and surgical intervention needs.
Main Results:
- Immature pelvises (open triradiate cartilage) showed more pubic rami and iliac wing fractures.
- Mature pelves (closed triradiate cartilage) had higher rates of acetabular fractures and diastasis.
- All surgically treated fractures requiring open reduction internal fixation occurred in mature pelves.
Conclusions:
- Pelvic fracture patterns significantly differ between immature and mature pediatric pelvises.
- Management should be tailored to skeletal maturity.
- Adult classification and management principles are applicable once the triradiate cartilage closes.
Abstract:
Orthopaedic traumatologists have recognized the unique fracture patterns and injury constellations of pediatric pelvic fractures. However, an understanding of the effect of advancing skeletal maturation is needed to avoid applying adult classifications and management. The authors determined how pelvic fracture patterns and management change with advancing skeletal maturity. At their pediatric trauma center, they identified 166 consecutive pelvic fractures. Eighty percent of patients had plain radiographs adequate to evaluate the triradiate cartilage. Physes were scored as open, narrowed, or closed. The Risser sign, fracture pattern, survival after injury, and need for open reduction and internal fixation were recorded. Ninety-seven patients (mean age 5.7 years) had an open triradiate or an "immature pelvis." Thirty-two patients (mean age 14 years) had a closed triradiate cartilage or a "mature pelvis." The immature group had a higher propensity for isolated pubic rami and iliac wing fractures. The mature group had a higher predilection for acetabular fractures and pubic or sacroiliac diastasis. All patients requiring open reduction and internal fixation had a mature pelvis. The incidences of specific pelvic fracture patterns between the two groups were statistically different. Management of fractures to the immature pelvis should focus on associated injuries. Once the triradiate cartilage has closed, adult pelvic fracture classifications and management principles should be used.