gms | German Medical Science

Objectives: Paediatric pelvic fractures are not commonly encountered and the surgical treatment is rarely indicated. Immature bony pelvis has anatomic peculiarities which would require special considerations if surgical treatment is planned.

Methods: We retrospectively reviewed all children (age < 18 years) who had operative fixation of unstable pelvic ring injuries during 5-year time period. Twenty patients were included in our study, 11 males and 9 females. Their average age was 12 years (range 4 - 17 years). Postoperative follow up ranged from 1 months to 3 years.

Results and Conclusion: Four children had type B injuries according to Tile's classification and 16 with type C injuries. The anterior pelvic ring failed through pubic rami in 14 patients, pubic symphysis diastasis (n=3; one with associated ipsilateral T-shaped acetabular fracture), combined pubic rami fracture and symphyseal injury (n=2) and one patient had trans-acetabular disruption (superior quadrant lesion). Posterior pelvic ring failure was through the ilium in 2 patients, sacroiliac joint (SI) dislocation (n=9), transiliac fracture dislocation of the SI joint (crescent iliac wing fracture with lateral compression injuries) with or without contralateral SI joint dislocation (n=4) and sacral impaction or fracture (n=5). Anterior ring fixation was accomplished by anterior supra-acetabular external fixation (n=12), anterior column plating (n=3), direct symphysis plating (n=1) or percutaneous acetabular screw fixation (n=1). Posterior ring fixation was performed using percutaneous iliosacral IS screw (n=8), iliac platting (n=2), lateral compression LC screw (n=1), a combination of IS screw + LC screw (n=1) or iliac plating (n=1), ilio-iliac bridge platting (n=1) and triangular internal fixation (n=1). Iliosacral screw fixation could be used as early as 6-years of age. In 3 out of 10 patients who had IS screw fixation, the screws pierced the soft iliac wing despite the use of washers and therefore they were reinserted through the holes of a plate in two cases. Anterior external fixator was used successfully for anterior stabilisation in 12 out of 16 patients, 3 of whom had pubic symphysis diastasis (had radiographic evidence of pubic apophysis avulsion rather than mid-substance ligaments tear). Eleven patients had open procedures exposing the iliac crest either anteriorly or posteriorly. In two patients, iliac crest apophyses avulsions from the bony ilium with attached trunk and abdominal muscles were sutured back to the ilium.

In conclusion, inserting IS screws in paediatrics might need to be done through plates used as big washers to prevent piercing the soft iliac wing. Anterior supra-acetabular external fixation can be used successfully for the treatment of pubic symphysis diatasis as the pathology is commonly a pubic apophysis bony avulsion. We should be aware of the variations in the encountered pathoanatomy in paediatrics and the presence of associated apophyseal disruptions around the ilium and the pubic symphysis.