Ryszard Tomaszewski1, Artur Gap. 1. Department of Paediatric Surgery, Trauma and Orthopaedic Ward, Upper Silesian Children's Health Centre, Katowice.
Abstract
BACKGROUND: Treatment of unstable pelvic fractures in children is a serious surgical problem. Despite similarities between the epidemiology, diagnosis and treatment of pelvic fractures in children and adults, this article attempts to demonstrate age-specific differences in patient management. MATERIAL AND METHODS: In a group of 46 children with pelvic fractures hospitalized in the years 2001-2009, 18 patients required surgical treatment. The fractures were classified according to Tile as type B1 fractures (11% of the patients operated on), type B2 (28%), B3 (22%), and C (39%). Surgical treatment was based on Gordon's classification. RESULTS: Patients were evaluated at 3, 6, and 12 months after surgery. All patients achieved radiological bone union by 3 months after surgery. The length of the lower limbs assessed at 12 months after surgery was the same in all patients. No patients demonstrated an oblique pelvic position. None of the patients had resting pain, but in one case there was slight pain in the sacro-iliac joint region due to incomplete reduction of sacro-iliac subluxation, but repeat surgery was not necessary. In one patient, there was a difference of approximately 15˚ in internal rotation of the hip joints caused by asymmetrical reduction of the pelvic fracture. One patient developed inflammation, which resolved after antibiotic therapy. CONCLUSIONS: Operative treatment of pelvic fractures in children over 8 years of age should be based on the principles of stable fixation and early rehabilitation, as it is in adults. Surgical treatment of unstable pelvic fractures with osteosynthesis in children is a challenge and needs expertise and a well-prepared multi-specialty team.
BACKGROUND: Treatment of unstable pelvic fractures in children is a serious surgical problem. Despite similarities between the epidemiology, diagnosis and treatment of pelvic fractures in children and adults, this article attempts to demonstrate age-specific differences in patient management. MATERIAL AND METHODS: In a group of 46 children with pelvic fractures hospitalized in the years 2001-2009, 18 patients required surgical treatment. The fractures were classified according to Tile as type B1 fractures (11% of the patients operated on), type B2 (28%), B3 (22%), and C (39%). Surgical treatment was based on Gordon's classification. RESULTS:Patients were evaluated at 3, 6, and 12 months after surgery. All patients achieved radiological bone union by 3 months after surgery. The length of the lower limbs assessed at 12 months after surgery was the same in all patients. No patients demonstrated an oblique pelvic position. None of the patients had resting pain, but in one case there was slight pain in the sacro-iliac joint region due to incomplete reduction of sacro-iliac subluxation, but repeat surgery was not necessary. In one patient, there was a difference of approximately 15˚ in internal rotation of the hip joints caused by asymmetrical reduction of the pelvic fracture. One patient developed inflammation, which resolved after antibiotic therapy. CONCLUSIONS: Operative treatment of pelvic fractures in children over 8 years of age should be based on the principles of stable fixation and early rehabilitation, as it is in adults. Surgical treatment of unstable pelvic fractures with osteosynthesis in children is a challenge and needs expertise and a well-prepared multi-specialty team.
Authors: Mohamed Arafa; Ahmed A Khalifa; Ali Fergany; Mostafa A Abdelhafez; Aly Mohamedean; Faisal Fahmy Adam; Osama Farouk Journal: Int Orthop Date: 2022-07-23 Impact factor: 3.479