Paediatric pelvic fractures: 10 years experience in a trauma centre

Fractures of the skeletally immature pelvis are relatively rare. We performed a retrospective analysis of 10 years experience of paediatric pelvic fractures in patients admitted a Level 1 Trauma Centre in London. All patients evacuated to the Royal London Hospital by the Helicopter Emergency Medical Service (HEMS) were entered on a comprehensive trauma database. This contains data about the time, date and mechanism of injury; nature of the injuries sustained; Injury Severity Score (ISS), Revised Trauma Score (RTS) and Glasgow Coma Scale (GCS). Patients were studied to obtain the following information in addition to that available from the trauma database: management of the pelvic fracture, length of stay in the intensive care unit and on the ward, and clinical outcome. Pelvic fractures were classified as open type or closed type and stable or unstable type in the database. 44 patients with pelvic fracture were admitted via HEMS in 10 years and seven patients died in that group. The mean age was 11.4 (range 6-16) and 28 male and 16 female patients. Commonest mechanism of injury was pedestrian hit by the car and predominantly stable type of injury was found in skeletally immature pelvis. Commonest associated injury was long bone fracture followed by head injury. ISS, GCS and RTS were significantly (p<0.05) altered in the non-survivors compared to the surviving group. All patients save one were treated conservatively allowing gradual mobilisation. In conclusion, pelvic fractures in children may themselves have a good long term outcome with conservative management, but they are an indicator of serious other bodily injuries which carry a high mortality.