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Paediatric pelvic fractures: how do they differ from adults?
E Hermans1, S T Cornelisse1, J Biert1
1Radboud University Medical Center, Department of Surgery, Division of Trauma Surgery, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
Insights
Pediatric pelvic fractures are rare and differ from adult fractures in presentation and injury patterns. Despite differences in management, mortality rates remain similar between pediatric and adult patients.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Pediatric Orthopedics
Background:
- Pediatric pelvic fractures are uncommon, necessitating a clear understanding of their unique characteristics.
- Comparing pediatric pelvic fractures with adult cases aids in optimizing treatment strategies.
Purpose of the Study:
- To review the incidence, presentation, treatment, and complications of pediatric pelvic fractures.
- To compare pediatric pelvic fracture data with adult pelvic fracture data.
Main Methods:
- Retrospective chart review of pediatric pelvic fractures (1993-2013).
- Comparison with adult pelvic fracture data (2007-2012).
Main Results:
- 51 children and 268 adults identified; children more involved in traffic accidents.
- Adults had higher Injury Severity Score (ISS) and hemodynamic instability; Type C fractures more common in adults, Type B in children.
- Mortality rates were similar (6% pediatric vs. 8% adult), often due to associated injuries.
Conclusions:
- Pediatric pelvic fractures present differently than adult fractures, with distinct associated injuries and management approaches.
- While rare, pediatric pelvic fractures carry a substantial mortality rate comparable to adults.
- Mortality in pediatric pelvic fractures is primarily attributed to concomitant injuries, not exsanguination.
Background:
The aim of this article was to review the incidence, presentation, treatment and complications of paediatric pelvic fractures of children who were admitted to our level 1 trauma centre and to compare them with our data from adult pelvic fracture patients.
Methods:
We conducted a retrospective chart review of all children with pelvic fractures who were managed at our institution between January 1993 and December 2013 and compared the data with our database on pelvic fractures in adults during the period 2007 to 2012.
Results:
We identified 51 children and 268 adults with pelvic fractures. The median age of the paediatric patients was 11 years. Children were significantly more involved in traffic accidents than adults (p < 0.001). Adults had a significantly higher Injury Severity Score (ISS) (31 vs 24.5; p < 0.03) and were significantly more often haemodynamically unstable (p < 0.01). Adults had a type C fracture more often, while children had a type B fracture (p < 0.001). Associated injuries were seen in both groups; however, thoracic injuries were significantly higher in adults (p < 0.01) and injuries to the extremities were higher in children (p < 0.01). Adults were significantly more often treated with open reduction and internal fixation (p < 0.001). Mortality in both groups, however, did not differ (6% vs 8%).
Conclusion:
Paediatric pelvic fractures are rare. They differ from adult pelvic fractures in presentation, associated injuries and management. Mortality, however, is substantial and does not differ from the adult population. Mortality is often due to concomitant injuries and not to exsanguination from the pelvic fracture.
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