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European Journal of Trauma and Emergency Surgery

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Open Access 03-10-2022 | Pelvic Trauma | Original Article

The clinical characteristics and management of paediatric pelvic fractures: a changing landscape based on skeletal maturity

Authors: Victor Lu, Shrav Gowrishankar, Zaki Arshad, Azeem Thahir, Jonathan Lenihan, Scott Mcdonald, Jaikirty Rawal, Peter Hull, Daud Chou, Andrew Carrothers

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2023

Abstract

Introduction

Paediatric pelvic fractures (PPFs) are uncommon but signify serious trauma. A comprehensive multidisciplinary approach is needed due to a high number of associated injuries. This study aims to retrospectively analyse PPFs over a 5-year period and evaluate how advancing skeletal maturity changes fracture patterns and management plans.

Methods

The trauma database was retrospectively reviewed for pelvic fractures in patients aged ≤ 18 years. Radiographs and CT scans were used to classify pelvic injuries according to the modified Torode classification and determine the status of the triradiate cartilage (open: skeletally immature; closed: skeletally mature). Data collected also included the mechanism of injury, clinical and functional outcomes, and associated injuries. Logistic regression analysis was performed to identify risk factors for associated abdominal injuries.

Results

65 PPFs (2.8% of paediatric trauma admissions during the study period) were classified as type I (3.1%), type II (7.7%), type IIIa (32.3%), type IIIb (38.5%), type IV (18.5%) according to the modified Torode classification. The mean age was 13.41 ± 3.82. Skeletally immature children were more likely to be hit by a motor vehicle as a pedestrian (p < 0.001), be intubated (p = 0.009), acquire Torode type II (p = 0.047) and rami fractures (p = 0.037), and receive chest (p = 0.005) and head injuries (p = 0.046). Skeletally immature children were also less likely to acquire Torode type IV fractures (p = 0.018), receive surgical treatment for their pelvic injuries (p = 0.036), and had a faster time to full weight bearing (p = 0.013). Pelvis AIS score ≥ 4 (OR 5.3; 95% CI 1.3–22.6; p = 0.023) and a pedestrian accident (OR 4.9; 95% CI 1.2–20.7; p = 0.030) were risk factors for associated abdominal injuries. There was a strong association between a higher pelvic fracture grade and the proportion of patients with closed triradiate cartilage (p = 0.036), hospital length of stay (p = 0.034), mean pelvic AIS score (p = 0.039), a pelvis AIS score of ≥ 4 (p = 0.022), mean ISS (p = 0.003), an ISS score between 25 and 75 (p = 0.004), average time to FWB (p = 0.001), requirement of blood products (p = 0.015), and a motor vehicle accident (p = 0.037).

Conclusion

PPFs occurring in skeletally mature and immature patients are significantly different in terms of mechanism of injury, fracture severity, fracture pattern, and management strategy. There is a high rate of associated injuries, necessitating an integrated multidisciplinary approach in paediatric trauma centres.

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Title: The clinical characteristics and management of paediatric pelvic fractures: a changing landscape based on skeletal maturity
Authors: Victor Lu
Shrav Gowrishankar
Zaki Arshad
Azeem Thahir
Jonathan Lenihan
Scott Mcdonald
Jaikirty Rawal
Peter Hull
Daud Chou
Andrew Carrothers
Publication date: 03-10-2022
Publisher: Springer Berlin Heidelberg
Keyword: Pelvic Trauma
Published in: European Journal of Trauma and Emergency Surgery / Issue 1/2023
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-022-02108-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The clinical characteristics and management of paediatric pelvic fractures: a changing landscape based on skeletal maturity

Abstract

Introduction

Methods

Results

Conclusion

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Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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