Session VI - Pediatrics
Outcome of Surgical Treatment of Unstable Pelvic Fractures in Children
Purpose: Purpose of this study was to show outcome following surgical treatment in unstable pelvic ring fractures in children under 16 years of age. Pelvic fractures in children are rare, about 1 in 100,000 per year (Karunakar et al 2005). Historically these have been managed non-operatively with bed rest, slings, traction etc, but studies have shown poor results in up to 30% of patients (Schwarz et al 1998).
Methods: A retrospective review was undertaken of unstable paediatric pelvic fractures between April 1992 and February 2002 at St George's Hospital. Twenty-seven patients were identified. There were 15 male patients and 12 female patients. Mean age was 13.3 (5 to 16) years. Six patients had triradiate apophysis open and 21 had triradiate closed, but iliac apophysis was open in all cases. There were 20 motor vehicle accidents, three falls from height and 4 falls from horses. There were 25 closed and 2 open fractures. There were 24 Tile type B and 3 type C fractures. Twenty-two (81%) patients had additional injuries. Twelve patients treated with external fixator alone, 5 with posterior internal fixation + external fixator, 5 with anterior + posterior internal fixation, 3 with anterior internal fixation, one with anterior internal fixation + external fixator and one with posterior internal fixation alone. Average follow up was 7.2 years (2-13 years).
Results: Twenty-four (89%) out of 27 patients had good results with no disability. Twenty-four (89%) had satisfactory radiological outcome. There was no impotence, dysparunia or urinary dysfunction reported in our series. One female had normal vaginal delivery while 2 others had LSCS. Four (15%) patients had superficial pin site infection. Three (11%) had limb length discrepancy (1-2 cm); one due to persistent pelvic obliquity and two others had ipsilateral femur and tibia fractures. One patient had sacroiliac and pubic instability that was treated with delayed fusion.
Conclusion/Significance: We conclude that anatomical alignment of pelvic ring by open or semi open methods produces good long-term clinical results. Orthopaedic management should be directed to restore pelvic symmetry to allow soft tissue healing. Operative repair can be performed safely with excellent results and an acceptable complication rate.