Assessing Pediatric Pelvic Fracture Patterns: New Insights and Unique Fracture Characteristics

Pediatric pelvic ring fractures are different in biomechanics and anatomy compared with adults. Existing classification systems are insufficient in assessing the mechanical stability of these fractures due to a variety of reasons, leading to a potential underestimation of the injury severity, resulting in suboptimal treatment with the risk of long-term dysfunctions. This study aims to address this problem by comprehensively describing a cohort of patients with pediatric pelvic fractures, identifying specific pediatric pelvic fractures and patterns.

A retrospective cohort selection of pediatric patients with a pelvic fracture treated in a major level 1 trauma center between 2001 and 2021 was conducted. Fracture patterns were classified using existing systems (Tile, Young and Burgess, Torode and Zieg), with additional parameters such as skeletal maturity considered. In addition, the incidence of specific pediatric fracture characteristics was reviewed.

The CT scans of 68 children were reviewed. The median age was 15.5 years, with a majority being female (53%). Traffic accidents were the primary mechanism of injury (65%). Most fractures were classified as Tile type B2 (53%) and Young & Burgess LC3 (32%). SI-joint avulsion fractures were frequently seen (n=14, 21%), predominantly in children with a mature pelvis (n=10, 71%). A significant proportion of fractures did not fit conventional classifications, with little difference between skeletally mature and immature patients (73% vs. 75%).

A large portion of skeletally mature and immature patients cannot be classified according to the currently existing classifications, highlighting the need for a tailored pediatric classification system. APC2-like fracture patterns had a high incidence of SI-joint avulsion fractures, so purely ligamentous APC-fracture patterns are, in our experience, very rare in children. In addition, a previously undescribed fracture pattern (ped-LC3) was identified. Future research is necessary to grasp the full concept of skeletal maturation on the biomechanics and distribution of forces in the pediatric pelvis.

Level III.