Fractures of the pelvis are rare in children. Only about one per cent of all fractures seen by orthopedic surgeons who treat children are in the pelvis. The cause is usually high-energy trauma from a car accident or sports injury.
This review article was written to help orthopedic surgeons evaluate and treat pediatric pelvic fractures. The authors compare and contrast adult to pediatric pelvic fractures.
Children are more likely to injure the organs in the abdomen. Adults are more likely to break the bones of the pelvis. In young children, the pelvic bones are still more cartilage than bone and less likely to break. Bleeding is less in children because they don’t have atherosclerosis (hardening of the arteries) yet. And their blood vessels vasoconstrict (close) quickly to shut off excess bleeding.
A step-by-step approach to diagnosis through the history, physical exam, and imaging tests is presented. First the accident patient is stabilized. Once life-threatening injuries have been taken care of, then other injuries such as pelvic fractures can be assessed and treated.
The medical team must look for internal bleeding and damage to the bladder and urethra. Hip motion is checked to see if the hip is dislocated. Nerve and blood vessels can also be damaged in a high-energy trauma. Neurovascular tests of the legs should be done to rule this out.
X-rays and CT scans are most helpful when identifying the presence, location, and type of pelvic fractures. MRIs have less value but may be used later to look for soft tissue and cartilage injury.
Treatment is usually nonoperative. The surgeon takes the child’s age and type of fracture into consideration. The authors present each type of fracture and review specific medical treatment for each one. Close observation and further tests may be needed for the child with an unstable fracture. In a small number of cases, surgery is required.
The prognosis is good for most children with pelvic fractures. Healing occurs quickly and without long-term problems. Complications can include leg length difference, low back pain, and early arthritic changes. Nerve injuries and myositis ossificans (bone forms in the muscle) can cause problems later.