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[Complex pelvic injury in childhood]
1Chirurgiche Universitätsklinik, Albert-Ludwigs-Universität Freiburg, Abteilung Unfallchirurgie. hagen.schmal@freenet.de
Insights
Pediatric pelvic disruptions are rare but complex, often involving severe injuries. Prompt diagnosis and a hierarchical treatment approach, prioritizing life-saving interventions, are crucial for optimal outcomes in children.
Area of Science:
- Pediatric Traumatology
- Orthopedic Surgery
- Emergency Medicine
Background:
- Pelvic disruptions are uncommon in children due to skeletal elasticity.
- Infantile pelvic fractures constitute less than 5% of cases, even in specialized centers.
- Children experience a higher proportion of complex pelvic injuries and polytrauma compared to adults.
Observation:
- Children's ability to compensate for blood loss can mask injury severity, delaying diagnosis and treatment.
- Severe pelvic injuries in children necessitate greater force and are often associated with significant associated injuries.
- Analysis of three pediatric cases highlighted the need for specific treatment algorithms.
Findings:
- Effective management requires recognizing all injury components and prioritizing treatment based on urgency.
- Unstable, dislocated pelvic fractures demand open reduction and internal fixation for neural decompression and hemorrhage control.
- Immediate diagnostic angiography with selective embolization is vital for managing acute hemorrhagic shock post-fracture stabilization.
Implications:
- A multidisciplinary approach involving various specialists in a trauma center is essential for achieving complete recovery.
- Early recognition and timely, hierarchical treatment are critical to prevent delayed management and improve patient outcomes.
- Addressing life-threatening conditions first, followed by associated injuries, significantly influences long-term quality of life.
Abstract:
Pelvic disruptions are rare in children caused by the flexible anchoring of bony parts associated with a high elasticity of the skeleton. Portion of pelvic fractures in infants is lower than 5% even when reviewing cases of specialized centers. The part of complex pelvic injuries and multiple injured patients in infants is higher when compared to adults, a fact caused by the more intense forces that are necessary to lead to pelvic disruption in children. Combination of a rare injury and the capability of children to compensate blood loss for a long time may implicate a wrong security and prolong diagnostic and therapeutic procedures--a problem that definitely should be avoided. Three cases were analyzed and established algorithms for treatment of patients matching these special injury-features demonstrated. A good outcome may only be achieved when all components of injury pattern get recognized and treatment is organized following the hierarchy of necessity. Therefore in the time table first life-saving steps have to be taken and then accompanying injuries can be treated that often decisively influence life quality. As seen in our cases unstable and dislocated fractures require open reduction and internal fixation ensuring nerval decompression, stop of hemorrhage and realizing the prerequisite for effective treatment of soft tissue damage. The acute hemorrhagic shock is one of the leading causes of death following severe pelvic injuries. After stabilization of fracture, surgical treatment of soft tissue injuries and intraabdominal bleeding sources the immediate diagnostic angiography possibly in combination with a therapeutic selective embolization is a well established part of the treatment. The aim of complete restitution can only be accomplished by cooperation of several different specialists and consultants in a trauma center.