Retrospective analysis of the treatment of pediatric unstable pelvic fractures

Objective To analyze the treatment of pediatric unstable pelvic fractures retrospectively and sum up the experiences and lessons.Methods From October 1998 to March 2011,30 patients of unstable pelvic fractures with an average age of 7.9 years were admitted.All these cases were Torode-Zieg type Ⅳ.Hemorrhagic shock was determined in 14 patients,and associated with other fractures in 11,urogenital system injuries in 14,sacral plexus injuries in 3,iliac vascular injuries in 2,and diaphragm rupture in one patient.Blood transfusion was done as a component of damage control in 13 cases.The pelvic fractures were treated conservatively in 15 patients,with external fixation in 9,with internal fixation in 4,and with combined external and internal fixation in 1 patients.Hemipelvectomy was performed in the remaining one case.Results One patient died during the emergent surgery due to severe hemorrhage.Thirteen patients werelost follow-up.Sixteen patients were followed up for 3 months to 11 years.According to Cole's grading scale,functional outcome was excellent in 12,good in 1,fair in 2,and poor in 1.Residual vertical displacement after skeletal traction caused inclination of pelvis and leg length discrepancy in one patient.Hip subluxation caused by sciatic nerve injury was found in one patient who severely limped in the last follow-up,and slight gait abnormality due to associated lumbosacral plexus injury was determined in one patient.Conclusion Treatment of pediatric unstable pelvic fractures is different with that of adult cases.Damage control is more significant for children than for adults.Skeletal traction remains one of the main resorts of managing pediatric unstable pelvic fracture,often predicting good functional outcomes.Surgical fixation should be adopted if residual vertical displacement cannot be corrected by skeletal traction,and should be minimal invasive as soon as possible.In addition,associated nerve injury is closely related to the functional prognosis and should be detected carefully and followed up closely. Key words: Child;  Pelvis;  Fractures, bone