Pelvic Fractures and Associated Urogenital Injuries in Children: A Systematic Review

Area of Science:

• Pediatric Orthopedics
• Pediatric Urology
• Trauma Surgery

Background:

• Traumatic pelvic injuries in children are less understood than in adults, despite significant anatomical differences.
• Urogenital sequelae following pediatric pelvic fractures are not comprehensively documented.
• This review addresses the characteristics, outcomes, and treatments of pediatric pelvic fractures with associated urogenital injuries.

Purpose of the Study:

• To identify characteristics of pediatric pelvic fractures and associated urogenital injuries.
• To understand the relationship between pelvic fractures, urogenital injuries, and their outcomes.
• To elucidate treatment modalities for pediatric pelvic fractures and concurrent urogenital injuries.

Main Methods:

• A systematic literature search was conducted across PubMed, Medline, SCOPUS, and Cochrane databases.
• PRISMA guidelines were followed, with 595 papers initially identified and screened.
• 29 studies involving 838 pediatric patients with pelvic ring fractures and urogenital injuries were included in the final analysis.

Main Results:

• Motor vehicle collisions were the most common cause of injury (58%).
• Urethral injuries were most frequent (90%), followed by bladder/bladder neck injuries (6.6%).
• Early urethral realignment and repair (49%) was the most common intervention, followed by delayed urethroplasty (42%).

Conclusions:

• Pediatric pelvic fractures, particularly high-energy injuries, frequently present with urogenital injuries like posterior urethral and bladder damage.
• Surgical management of pelvic fractures involved fixation and plating, while urogenital injuries were often treated with early urethral realignment.
• The optimal timing for surgical repair of urogenital injuries is debated, with evolving endoscopic techniques influencing early intervention popularity.