OTA 1997 Posters - Pediatrics

Long-Term Outcome of Open Pelvic Fractures in Children

Rami Mosheiff, A. Suchar, S. Porat, D. Segal, M. Liebergall

Hadassah University Hospital, Jerusalem, Israel

The purpose of this retrospective analysis was to review the outcome of open pelvic fractures in children.

Methods: Medical records, radiographs and C.T. scans of all children with open pelvic fractures admitted to our trauma center between 1983 and 1995 were reviewed. The children's age ranged from 4.5 to 12 (mean 7 years). Eight of them were males and seven were females. 93% of the children (n=14) were injured in motor vehicle accidents - all being pedestrians. Only one was injured in a different mechanism of injury - gun shot wound. All children were admitted to the Emergency Room directly from the scene of the accident. Pelvic fractures were classified according to the OTA (Tile) classification. The minimal follow-up on the survivors was two years (average - 35 months).

Results: Thirteen children suffered from one or more additional major injuries. Only two sustained an isolated pelvic fracture. Most concomitant injuries were in proximity to the pelvis. Ten children had C-type fractures. Ten children sustained other musculoskeletal injuries. Of the 15 children, 20% (n=3) died a few hours after admission due to uncontrollable hemorrhage (n=2) and chest injury (n=l). There were no deaths due to late complications. However, of the twelve survivors, all suffered from late complications. Deep wound infection and sepsis were the most common complications noted (n=11). Nine children needed late additional surgery (average - 3). The common repeated surgeries were debridement, skin grafting of affected areas, and late closure of colostomies and cystostomies. Ten children underwent placement of external fixation early in the course of treatment for pelvic stabilization and control of hemorrhage. Five needed internal fixation of their fractures for stabilization of posterior elements.

Discussion and Conclusions: Open pelvic fractures in children is a rare and complex injury, often involving intra-abdominal organs, major blood vessels and soft tissue injuries. From our experience, the major cause of open pelvic fractures in children is motor-pedestrian accidents - making up 93% of the cases. This is contrary to adults, where motor-pedestrian accidents account for less than 50% of the cases. A significant finding is that in most patients the pelvis and immediate surrounding area were the locations of the major injuries. This may be attributed to the height of the contact point between the child and the fender of the car, or in some cases where the wheel ran over the child's pelvis. Despite the severity of trauma, we found mortality to be only 20% (n=3). This being the case, a higher percentage of these children survive and treatment should be aimed at giving them the best quality of life possible under the circumstances. A major problem which often complicates the treatment is sepsis and deep infection originating from anorectal and genitourinary excretions. In order to minimize complications, aggressive intervention is needed including irrigation, debridement, intravenous antibiotics and diverging colostomies and cystostomies. External fixation of the pelvis is not always sufficient, and for achieving better stabilization of the pelvis, open reduction and internal fixation should be considered.