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[Internal osteosynthesis after unstable pelvic ring fracture in a 3-year-old child]
A Gänsslen1, T Pohlemann, T Hüfner
1Unfallchirurgische Klinik, Medizinische Hochschule Hannover.
Insights
A pediatric pelvic ring fracture (Tile type C) in a 3-year-old was successfully treated with immediate internal fixation. Surgical repair ensured anatomical healing and normal pelvic development after 12 months.
Area of Science:
- Orthopedic surgery
- Pediatric trauma
- Pelvic fracture management
Background:
- Unstable pelvic ring fractures in children are rare but can result from severe trauma.
- A 3-year-old sustained a Tile type C pelvic fracture with sacroiliac joint disruption and pubic symphysis injury.
- Prompt surgical intervention is crucial for managing such complex pediatric pelvic injuries.
Observation:
- The patient experienced a severe pelvic ring fracture due to being trapped under a forklift.
- The injury involved complete sacroiliac (SI) joint disruption, pubic symphysis disruption, and external rotation of the contralateral SI joint.
- Immediate internal fixation was performed, addressing both the SI joint and pubic symphysis simultaneously.
Findings:
- An H-plate was used for anterior SI joint fixation, and screws with cerclage wires stabilized the pubic symphysis.
- Following one revision of the symphysis, the patient had an uneventful recovery with anatomical healing of the pelvic ring.
- Implants were removed after 4 months, with 12-month follow-up showing no signs of pelvic ring maldevelopment.
Implications:
- This case demonstrates the feasibility and effectiveness of immediate internal fixation for severe pediatric pelvic ring fractures.
- Simultaneous surgical exposure and fixation of the SI joint and pubic symphysis can achieve anatomical reduction and stable healing.
- Successful management in pediatric patients can prevent long-term sequelae such as pelvic maldevelopment.
Abstract:
A 3-year-old child was trapped under the heavy load of a forklift truck and sustained an unstable pelvic ring fracture (Tile type C) with complete SI disruption, disruption of the public symphysis and external rotation injury of the contralateral SI joint. An immediate internal fixation was performed, exposing the SI joint and the public symphysis simultaneously. For stabilization an H-plate was used for anterior plate fixation of the SI joint, while the public symphysis was stabilized by screws and cerclage wires. After one revision of the symphysis the clinical course was uneventful with anatomical healing of the pelvic ring. The implants were removed after 4 months. Clinical and radiological follow-up after 12 months showed no signs of maldevelopment of the pelvic ring.