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[Abdominal trauma and pelvic injury in the growth period]
H Rieger1, H S Neumann, W Klein
1Klinik und Poliklinik für Unfall- und Handchirurgie, Westfälische Wilhelms-Universität Münster.
Insights
Children with pelvic fractures often have other injuries, with concomitant abdominal and pelvic trauma being common. Long-term health issues in these pediatric patients typically stem from these associated injuries.
Area of Science:
- Orthopedic Surgery
- Pediatric Trauma
- Emergency Medicine
Background:
- Pelvic fractures in children are frequently associated with polytrauma.
- Concomitant abdominal and pelvic injuries are common in pediatric pelvic fractures.
- This study reviews cases of pediatric pelvic fractures treated between 1974 and 1993.
Observation:
- A review of 54 pediatric pelvic fracture cases revealed 87% had concomitant injuries.
- Common associated injuries included genitourinary lesions (15), open fractures with rectal/vaginal tears (9), and significant pelvic hematomas (11).
- Organ injuries observed during laparotomy included liver (7), spleen (7), kidneys (2), and small bowel (1).
Findings:
- The mean Polytrauma Score was 23.7 and the mean Injury Severity Score was 30.5.
- Mortality was 14.8% (8 children), with 5 deaths attributed to abdominal/retroperitoneal bleeding.
- Follow-up in 81.8% of patients indicated long-term morbidity primarily linked to associated pelvic injuries.
Implications:
- Pediatric pelvic fractures require a comprehensive trauma assessment due to high rates of associated injuries.
- Early identification and management of abdominal and pelvic injuries are critical for reducing mortality.
- Associated injuries significantly impact long-term outcomes in children with pelvic fractures.
Abstract:
Children with pelvic fractures usually are polytraumatized. Concomitant abdominal and pelvic injuries are not uncommon. Medical records and X-rays of 54 children, in which a pelvic fracture was diagnosed at our institution from 1974-1993, were reviewed. Children ages < or = 16 years and treated as in-patients were included in this study. The fractures were classified according to the AO-Classification. 47 patients (87.0%) had concomitant injuries. The mean Polytrauma Score was 23.7 (mean Injury Severity Score 30.5). Nine Children sustained an open pelvic fracture with rectal and/or vaginal tear. 15 genitourinary lesions were found in 13 children. 18 patients underwent laparotomy. A large pelvic/retroperitoneal hematoma was found in 11 cases. There were 7 liver lacerations, 7 splenic injuries, 2 mesenteric tears, 2 kidney injuries and 1 small bowel lesion. Eight children (14.8%) died with 5 of them due to retroperitoneal or/and abdominal bleeding complications. A recent follow-up examination (81.8%) with a mean follow-up of 11.3 years showed that long-term morbidity usually was attributed to pelvic concomitant injuries.