Therapeutic effect of an external fixator in the treatment of unstable pelvic fractures in children

Analysis of risk factors affecting the prognosis of external fixation in the treatment of unstable pelvic fractures in children: a retrospective study of 96 patients

BACKGROUND

To investigate the efficacy of external fixation in treating unstable pelvic fractures in children and identify risk factors for poor prognosis.

METHODS

A retrospective study was conducted on children with unstable pelvic fractures treated surgically at our hospital from January 2006 to June 2022. All patients received external fixation, and those with vertical instability underwent postoperative limb traction. Data collected included gender, age, injury mechanism, associated injuries, imaging results, operation time, blood loss, pelvic reduction status, complications, and functional recovery. Variables were analyzed using multiple linear regression to explore risk factors for poor prognosis.

RESULTS

The study included 96 patients (62 males, 34 females) with an average age of 95.7 ± 50.3 months. Injury mechanisms were mainly traffic accidents (82.3%) and falls (14.6%). There were 47 cases of Tile B fractures and 49 cases of Tile C fractures. Surgeries were successful with an average operation time of 55.6 ± 27.3 min and blood loss of 6.3 ± 4.7 ml. Immediate postoperative Matta reduction quality was excellent in 91.7% of cases. Postoperatively, 46 patients underwent limb traction for an average of 9.3 ± 1.4 weeks. The average follow-up duration was 29.3 ± 11.7 months, and fracture healing time was 8.6 ± 1.1 weeks. At the final follow-up, 83.3% had excellent or good Cole pelvic function scores. WeeFIM scores indicated complete independence in 71 cases, conditional independence in 13, and conditional dependence in 12. Multiple linear regression identified age, Tile classification, and immediate postoperative displacement as independent predictors of prognosis. Patients aged ≥ 13 years, with Tile C fractures, and immediate postoperative displacement ≥ 8 mm had lower Cole scores.

CONCLUSIONS

External fixation combined with lower limb traction effectively treats unstable pelvic fractures in children, with most patients having a favorable prognosis. Assessment of age, fracture type, and reduction quality is essential. Enhanced postoperative follow-up and functional exercises are recommended for older children, those with Tile C fractures, and those with significant immediate postoperative displacement. Clinicians should consider these factors to improve outcomes.

LEVEL OF EVIDENCE

III.

Pediatric-Specific Lesions in Unstable Pelvic Ring Fractures of Skeletally Immature Children: Impact on Diagnosis and Management Decisions

Surgical fixation of pediatric pelvic ring injuries is gaining popularity to avoid the poor long-term outcomes of pelvic asymmetry. The surgical techniques and fixation choices depend on the individual injuries affecting the anterior and posterior pelvic ring areas. The immature bony pelvis of young children has anatomic differences including soft bones, elastic ligaments, and the presence of growth centers. Understanding the unique pediatric lesions with unstable pelvic fractures is essential for treatment decisions. Anterior lesions include pubic symphysis disruption through the pubic apophysis, single ramus fractures, pubic rami fractures through the triradiate cartilage, and/or the ischiopubic synchondrosis; ischiopubic ramus infolding injury; or the unstable superior and inferior quadrant lesions. Posterior pelvic lesions include iliac wing infolding and sacroiliac joint dislocation or transiliac (crescent) fracture/dislocations through the iliac apophysis growth plate. Pubic symphysis and sacroiliac disruptions are physeal injuries in children, and they have excellent healing potential. External fixation is an ideal choice for anterior ring fixation including bony and pubic symphysis injuries. Posterior lesions are mostly sacroiliac joint disruptions with iliac apophysis separation that can serve as a landmark for vertical displacement correction. Posterior lesions can be treated by percutaneous iliosacral screw fixation or open reduction techniques.

Surgical management of paediatric pelvic fractures: a prospective case series and early experience from a level one Egyptian trauma centre

PURPOSE

We aimed to report our early experience treating paediatric pelvic fractures (PPF) surgically, reporting on indications, outcomes, and complications.

METHODS

Patients aged 0-15 with PPF treated surgically at a level I trauma centre were included prospectively between 2016 and 2018. Fractures were classified according to AO/OTA classification system. Functional evaluation was performed using a modification of the Majeed functional scoring system. Radiological evaluation of vertical and posterior displacement was performed according to Matta and Tornetta criteria and the method described by Keshishyan et al. for assessing pelvic rotational asymmetry.

RESULTS

We included 45 patients (77.8% males and 22.2% females), with a mean age of 9.53 ± 3.63 and 19.87 ± 8.84 months of mean follow-up. The functional outcome was excellent in 42 (93.3%) patients, good in two (4.4%), and fair in one (2.2%). Radiologically, the vertical displacement improved from 5.91 ± 4.64 to 3.72 ± 2.87 mm (p-value 0.065), the posterior displacement improved from 7.87 ± 8.18 to 5.33 ± 13.4 mm (p-value 0.031), and the symphyseal diastasis improved from 9.88 ± 7.51 mm to 7.68 ± 3.18 mm (p-value 0.071). Residual pelvic asymmetry improved from 1.2 ± 0.61 to 0.8 ± 0.7 (p-value 0.001). Complications occurred in 21 (46.7%) patients, 11 (24.4%) pin tract infection, six (13.3%) limb length discrepancy, two (4.4%) prominent metals, one (2.2%) subcutaneous haematoma, one (2.2%) infected ISS.

CONCLUSIONS

We achieved acceptable functional and radiological outcomes after surgically treating a group of patients with PPF, which was relatively safe with minimal complications. The proper approach and fracture fixation tool should be tailored according to the fracture classification and the presence of associated injuries.