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Pediatric Acetabular Fractures:
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Discussion:
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characteristics of pediatric pelvic fracture:
- in the report by JS Silber et al, the authors identified 166 consecutive pelvic fractures;
- physes were scored as open, narrowed, or closed;
- risser sign, fracture pattern, survival after injury, and need for open reduction and internal fixation were recorded;
- 97 patients (mean age 5.7 years) had an open triradiate or an "immature pelvis."
- 32 patients (mean age 14 years) had a closed triradiate cartilage or a "mature pelvis."
- immature group had a higher propensity for isolated pubic rami and iliac wing fractures.
- management of fractures to the immature pelvis should focus on associated injuries.
- mature group had a higher predilection for acetabular fractures and pubic or sacroiliac diastasis.
- all patients requiring open reduction and internal fixation had a mature pelvis.
- once the triradiate cartilage has closed, adult pelvic fracture classifications and management principles should be used;
- ref: Skeletal Maturation: Implications for Classification and Management
Jeff S. Silber, M.D. John M. Flynn, M.D.
J Pediatr Orthop 2002 January/February;22(1):22-26
- Treatment:
- in the report by
Blasier RD et al (CORR 2000 Jul;(376):87-95)
- the authors retrospectively reviewed the medical records and radiographs of 189 patients with pelvic ring
disruptions who were evaluated at a tertiary care children's hospital during a 10-year period.
- of the 189 patients, 57 were identified with unstable pelvic fractures.
- 43 of these patients were available to complete a subjective evaluation of their treatment at midterm followup.
- 13 patients were treated operatively and 30 were treated nonoperatively.
- there was no significant difference in subjective scoring between the two groups for pain at rest, pain
with activity, limp, leg length discrepancy, and overall satisfaction with treatment.
- there were 92% good or excellent results in the patients who were treated operatively and 80% good or
excellent results in the patients who were treated nonoperatively.
Pediatric pelvic ring fractures.
Selective management of pediatric pelvic fractures: a conservative approach.
Pelvic fractures in children--review of 120 patients with a new look at general management.
Pelvic disruptions in children.
Death from pelvic fracture: children are different.
N Ismail et al.
J. Pediatric Surg. Vol 31(1) 1996. p 82-85.
Pelvic fractures in children.
Pelvic polyfractures in children. Radiographic diagnosis and treatment.
Pelvic fractures and associated injuries in children.
Clinical Outcomes of Unstable Pelvic Fractures in Skeletally Immature Patients.
