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Pediatric pelvic fractures.

Candice P Holden1, Joel Holman, Martin J Herman

  • 1Department of Orthopedics, Alfred I. duPont Hospital for Children, Wilmington, DE, USA.

The Journal of the American Academy of Orthopaedic Surgeons
|March 8, 2007
PubMed
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Pediatric pelvic fractures are rare, often caused by high-energy trauma. Most cases are treated non-surgically, but surgical intervention is necessary for significant displacement or specific fracture types to prevent long-term complications.

Area of Science:

  • Orthopaedic Surgery
  • Pediatric Traumatology
  • Pediatric Radiology

Background:

  • Pediatric pelvic fractures represent a small fraction (1-2%) of childhood fractures.
  • These injuries typically result from high-energy trauma, necessitating thorough evaluation for life-threatening associated conditions.

Purpose of the Study:

  • To outline the diagnostic standards and treatment strategies for pediatric pelvic fractures.
  • To detail potential complications associated with pediatric pelvic fractures and their management.

Main Methods:

  • Diagnosis relies on anteroposterior radiographs and rapid-sequence computed tomography (CT) scans.
  • Treatment is tailored to patient age, fracture classification, pelvic ring stability, associated injuries, and hemodynamic status.

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Main Results:

  • The majority of pediatric pelvic fractures are managed non-surgically with protected weight-bearing and gradual activity resumption.
  • Surgical intervention (open reduction and internal fixation) is indicated for acetabular fractures with >2 mm displacement or intra-articular/triradiate cartilage displacement >2 mm.
  • External fixation is required for pelvic ring displacement >2 cm to prevent limb-length discrepancies.

Conclusions:

  • Immature triradiate cartilage fractures can lead to acetabular growth disturbances, hip dysplasia, subluxation, or incongruity.
  • Potential complications include osteonecrosis of the femoral head, myositis ossificans, and neurological deficits.
  • Individualized treatment based on fracture characteristics and patient stability is crucial for optimal outcomes in pediatric pelvic fractures.