Fractures of the pelvis in children

Pelvic bony injuries are uncommon in children except for avulsion fractures. Medical records and radiographs of 54 children, in whom pelvic fractures were diagnosed from 1974 to 1993, were reviewed. Children 16 years of age and younger who were treated as inpatients were included in this study. Thirty-two patients were boys (59.3%) and 22 were girls (40.7%). In 47 (87.0%) patients, trauma was caused by motor vehicle accidents. The fractures were classified according to the Torode and Zieg classification and the Tile AO/Association for the Study of Internal Fixation classification. Forty-seven (87.0%) children had associated pelvic or extrapelvic injuries. The mean Injury Severity Score was 30.5 (range, 4-66). The AO classification correlated well with the severity of the injury. Eight children (14.8%) died. In most (38 patients = 70.4%) patients, the pelvic bony injury was treated by conservative means. External or internal fixation of the fracture was performed in 16 (29.6%) patients. A followup examination was conducted in 35 of 44 survivors (79.5%; 2 other patients died of unknown causes) with a mean followup of 135 months (range, 18-235 months); 1 additional patient was interviewed by telephone. In this series, long term morbidity was rare and was attributed to severe pelvic ring disruptions, acetabular fractures, or concomitant injuries. It is concluded that in unstable pelvic ring disruptions and acetabular fractures, the principles of management in children should not differ greatly from those in adults. Serious associated pelvic or extrapelvic injuries may pose more management problems than does the pelvic fracture.