Pediatric Pelvic Fracture: A Modification of a Preexisting Classification

Department of Orthopaedics, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
Journal of pediatric orthopedics (Impact Factor: 1.47). 03/2012; 32(2):162-8. DOI: 10.1097/BPO.0b013e3182408be6
Source: PubMed


The classic pediatric pelvic fracture (PPF) classification was developed by Torode and Zeig in 1985 and is based exclusively on plain radiographs. The purpose of this study was to propose a modification to a previously accepted PPF classification scheme and discuss the significance of this modification with respect to treatment and management of PPF over an 8-year period at a large pediatric hospital.
PPFs were recorded on a prospectively identified hospital registry of all trauma admissions. Pelvic x-rays and computerized tomography scans were reviewed and classified according to a modified classification scheme. Correlation was made with age, sex, mechanism, associated injuries, intensive care unit stay, operations, and discharge outcome. Blood product usage was obtained from a hematology database.
A total of 124 children were identified with PPF, comprising 1.6% of trauma admissions between July 2000 and June 2008. Radiology was available for 115 children (58 boys, and 57 girls, mean age 11.5 y). According to the modified classification, 71% (82/115) had type III-A or III-B injuries (type I=5 children, type II=17 children, type IV=11 children). There was a mortality of 5% (6/115 children) during the study. Eighty-one percent (93/115) of PPF resulted from being involved in a motor vehicle accident (occupant or pedestrian). Trend testing showed relationships between increasing fracture type and length of stay (P<0.001), as well as the need for blood transfusion (P=0.009) or pelvic operation (P<0.001). A total of 34 (30%, 34/115) children required blood products. Type III-B injuries were more likely to receive blood products than type III-A injuries (odds ratio 3.58; 95% confidence interval, 1.28-10.03).
: The modified Torode PPV classification is predictive for significant morbidity and death in the setting of multitrauma. Stable type III-B fractures are indicative of increased blood product use, intensive care unit requirement, and overall hospital stay. This modified classification scheme will aid health care providers at all levels in managing PPF more efficiently during their initial resuscitation and treatment period.
Level III-retrospective case control study.

31 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Apophyseal avulsion fractures are uncommon injuries that usually occur after a sudden and forceful muscle contraction. The diagnosis is fundamentally clinical, suggested by the patient's age and injury mechanism. A plain radiograph usually confirms the diagnosis, but ultrasound, computed tomography and magnetic resonance imaging may be useful. Conservative treatment is usually successful in most cases. We report two cases of pelvic apophyseal avulsion fractures with different location, clinical presentation and outcome in young soccer players. In the first case, we present an avulsion of the lesser trochanter, a very uncommon injury, and in the second case an avulsion of the anterior-inferior iliac spine that went unnoticed and was diagnosed a month after the injury. With careful understanding of the anatomy, mechanism of injury and treatment, these fractures can be successfully diagnosed and treated.
    No preview · Article · Jan 2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: Fractures of the pelvis in pediatric population are extremely rare. Children with complex pelvic fractures are most often pedestrians who have been struck by a motor vehicle. Head injuries are the main cause of death, unlike the adult, where severe hemorrhages are common and contribute to mortality. Long-term follow-up studies have reported significant residual morbidity in children's pelvic fractures treated non-operatively. The aim of this study is to analyze our cases in order to evaluate the final outcome and to suggest the surgical indications for the management of this kind of injuries. From January 2000 to July 2011, eight pediatric patients were surgically treated for pelvic ring fractures in our department. The functional result at follow-up was evaluated using the functional independence measure (FIM). In most cases the clinical outcome was good with functional recovery of the hip and complete resumption of physical activity. The mean FIM score was 125.3. One patient underwent permanent colostomy for perineal lacerations, one case showed a slight scoliosis at follow-up, and one patient showed the early fusion of the triradiate cartilage. One patient presented a deep thrombosis of the common femoral vein. Fractures of the pelvic ring should be carefully assessed by radiographs and CT scan. The centralization of these young patients is important to get the experience and ensure the proper treatment. A correct indication for surgery may prevent or limit the consequences of these complex fractures.
    No preview · Article · Jul 2013 · MUSCULOSKELETAL SURGERY
  • [Show abstract] [Hide abstract]
    ABSTRACT: U-shaped sacral fractures or Jumper's fractures are rare injuries in adults and are even rarer in the pediatric population. These fractures share a common pathoanatomy where the pelvis as a unit together with the bilateral alar parts and the lower part of the sacrum, loses its skeletal and soft tissue connections to the remaining axial skeleton and hence the term spinopelvic dissociation. This report describes an unusual pattern of spinopelvic dissociation in a young child where the transverse process of the fifth lumbar vertebra was avulsed on one side (spinal side avulsion), whereas on the other side, complete iliac crest apophyseal avulsion took place (pelvic sided avulsion). To our knowledge, this combination of injuries was not reported before. The available literature describing pediatric U-shaped sacral fractures were also reviewed to help explain the pathoanatomic basis of this association. An 8-year-old boy sustained a U-shaped sacral fracture with avulsion of the left iliac crest apophysis. A search in the English literature was performed for all reports of U-shaped sacral fractures in pediatric patients (≤18 y of age), as well as the relevant literature, which describes the pathoanatomy, possible radiologic findings, and current classification systems and treatment options. Fixation using a 7.3 mm percutaneous iliosacral screw was performed. At the latest follow-up, the child had no pain, was fully bearing weight on lower extremities, and was neurologically intact. The literature review yielded 6 other pediatric patients with U-shaped sacral fractures in 4 articles. In young children with immature pelvis, the iliac apophysis may be avulsed instead of the transverse process of the fifth lumbar vertebra by forces transmitted through the iliolumbar ligament. The apophysis will therefore keep its attachment to the abdominal and trunk muscles, whereas the bony iliac wing and the pelvis would be dissociated from the axial skeleton. Otherwise, the pathoanatomy of these injuries is the same as described in adults. Level IV.
    No preview · Article · Dec 2013 · Journal of pediatric orthopedics
Show more