Pediatric Pelvic Fractures and Differences Compared w/ the Adult Population

Key Points:

• Pelvic fractures in children are a very common pathology. Their incidence has been reported to be 2.4% to 7.5%, much lower than the incidence in the adult population, estimated in the literature at 23%.

• The skeletally immature pelvis has greater plasticity and flexibility compared with the adult pelvis because it contains a large percentage of cartilage, a more porous cortical bone, and, above all, a greater elasticity in the pubic symphysis and sacroiliac joints.

• Therefore, when we observe a pediatric pelvic fracture, we have to suspect a high-energy trauma and its possible systemic complications.

• Type I fractures are avulsion injuries, type II are fractures involving the iliac wing, and type III lesions are stable pelvic ring fractures, whereas in type IV, stability is affected.

• A total of 81 patients were used for this study. The mean age was 9.98 years at the time of injury, and of the 81 patients, 50 were boys (61.72%) and 31 were girls (38.27%).

• The most common mechanism of injury was a pedestrian-motor vehicle accident trauma (74.1%, 60/81), followed by falls from a great height (16%, 13/81) and most of the remaining cases (9.9%, 8/81 were caused by crushing.

• Associated injuries were present in 77.8% (63/81) of the patients. Forty-five (55.5%) of 81 patients had fractures in other locations, 40 (49.4%) had head trauma, 20 (24.7%) had abdominal injuries, 9 (11.1%) had urogenital injuries, and 6 (7.4%) had diaphragmatic trauma.

• Death rate was 8.64% (7/81); 5 patients died after a massive head trauma, one died after a thoracic trauma, and one died because of a diaphragmatic rupture.

• Regarding the treatment, most pediatric pelvic injuries can be managed non operatively, but in unstable fracture patterns, surgical treatment is necessary.

• A characteristic pattern of fracture in children that cannot be managed conservatively is the "crescent" fracture.

• In conclusion, the great plasticity and elasticity present in a child pelvis allow it to absorb a lot of energy before a fracture occurs, so when a child has a fracture in this location, although the pattern is usually stable, a high energy mechanism will probably be involved. Therefore, vital soft tissue damage may be present and treating it should prevail over the pelvis fracture management.

Reference:

De la Calva, C., Jover, N., Alonso, J., & Salom, M. (2020). Pediatric pelvic fractures and differences compared with the adult population. Pediatric Emergency Care, 36(11), 519–522. https://doi.org/10.1097/pec.0000000000001411