Clinical characteristics, injury pattern and management of pediatric pelvic fracture: An observational retrospective study from a level I trauma center.

BACKGROUND: Pediatric pelvic fractures (PPF) are uncommon among children requiring hospitalization after blunt trauma. The present study explored our experience for the prevalence, patients demographics, clinical characteristics, injury pattern and management of pediatric pelvic fractures in a level I trauma center. METHODS: This is a retrospective review of prospectively collected data obtained from trauma registry database for all pediatrics trauma patients of age ≤18 years. Data were analyzed according to different aspects relevant to the clinical applications such as Torode classification for pelvic ring fracture (Type I-IV), open versus closed triradiate cartilage, and surgical versus non-surgical management. RESULTS: During the study period (3 and half years), a total of 119 PPF cases were admitted at the trauma center (11% of total pediatric admissions); the majority had pelvic ring fractures (91.6%) and 8.4% had an acetabular fracture. The mean age of patients was 11.5 ± 5.7, and the majority were males (78.2%). One hundred and four fractures were classified as type I (5.8%), type II (13.5%), type III (68.3%) and type IV (12.5%). Patients in the surgical group were more likely to have higher pelvis AIS (p = 0.001), type IV fractures, acetabular fractures and closed triradiate cartilage as compared to the conservative group. Type III fractures and open triradiate cartilage were significantly higher in the conservative group (p < 0.05). Patients with closed triradiate cartilage frequently sustained spine, head injuries, acetabular fracture and had higher mean ISS and pelvis AIS (p < 0.01) than the open group. However, the rate of in-hospital complications and mortality were comparable among different groups. The overall mortality rate was 2.5%. CONCLUSION: PPF are uncommon and mainly caused by high-impact trauma associated with multisystem injuries. The majority of PPF are stable, despite the underlying high-energy mechanism. Management of PPF depends on the severity of fracture as patients with higher grade fractures require surgical intervention. Furthermore, larger prospective study is needed to understand the age-related pattern and management of PPF.

Percutaneous sacroiliac screw fixation in a pediatric with unstable bilateral superior rami and sacral fracture-dislocation; a case report and review of the literature.

Complex pelvic ring injuries in childhood can be difficult to treat, and literature mentions several techniques for fixing SIJ fracture-dislocations. In accordance with the CAse REport (CARE) guidelines, this study describes a five-year-old boy with a complex pelvic ring fracture caused by a car accident: vertically unstable pelvic fracture consists of bilateral superior rami fractures and type I of Denis sacral fracture. Fixation was achieved by inserting a 6.5 mm major diameter cannulated screw with a 60 mm length and 16 thread into the SIJ at the level of S1. The pelvic inlet view corrected the anterior-posterior position, and the pelvic outlet view adjusted the superior-inferior position to determine a suitable sacral level. After three months, the SI joint has shown an anatomically fracture consolidation, and he could ambulate with full weight-bearing and full ROM with no pain. A 3-year follow-up showed promising results in radiological and functional terms. We conclude that percutaneous SI screw fixation using a cannulated screw is a suitable technique for pediatrics because it provides anatomic reductions and is minimally invasive. Children as young as five can be treated safely with SI screws for sacral fractures and SIJ injuries.

Case report: Hysteroscopy combined with a vaginal mold for severe recurrent vaginal adhesion and stenosis with pyocolpos after pelvic fracture in a 13-year-old female.

Vaginal adhesions and stenosis are infrequent long-term sequelae following pediatric pelvic fractures. Patients may not present with signs and symptoms before menarche, leading to delayed diagnosis and treatment. We report an adolescent girl who presented with a post-abdominal trauma pelvic fracture and urethrovaginal fistula and subsequent severe vaginal adhesion, which resulted in infection and obstructive symptoms after menarche. Hysteroscopy-guided vaginal adhesion release using an epidural catheter and ultrasonography was performed, followed by vaginal dilation, to resolve obstructive symptoms. For girls with pelvic fractures, education on possible long-term sequelae is required, as is regular follow-up. Timely diagnosis and treatment are important, and hysteroscopic release of vaginal adhesion and postoperative regular vaginal dilation may be an effective treatment.

Open complete anterior dislocation of the sacro-iliac joint in a 4-year-old boy: a case report of a rare injury with 5-year follow-up.

Pelvic fractures are uncommon in children and account for between 0.3 and 7.5% of all pediatric injuries. Open pelvic fractures only account for up to 12.9% of all pediatric pelvic fractures. An unusual case of open complete anterior sacro-iliac joint dislocation in a 4-year-old boy is presented with a long-term follow-up. The multidisciplinary approach is reported with review of the current literature. A 4-year-old male presented to our institution in January 2012 after having been run over by a tractor. He presented with gross hemodynamical instability, MISS of 25, and an unstable lateral compression type III pelvic fracture with complete anterior dislocation of the left hemipelvis and a groin wound extending into the left thigh. The patient was managed in accordance with the ATLS and open fracture guidelines. Reduction in the dislocated SI joint was achieved via a posterior approach to the SI joint, followed by fixation with 2K wires in S1 and S2 sacral segments, with an anterior external fixator. Pelvic asymmetry post-reduction was 0.9 cm, compared to 16 cm post-injury, and asymmetry persisted till final follow-up at 5 years. At 5 years, patient regained full function, including recreational sport activities. Patients scored a 96/96 on the Majeed score (after excluding 4 points for sexual function). We believe that posterior reduction in an anteriorly dislocated SI joint in the pediatric population is a viable option. A coordinated, multidisciplinary approach and restoration of pelvic ring stability can lead to optimal outcome.