Pediatric Pelvic Fractures and Differences Compared w/ the Adult Population
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.
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