Outcomes of Pediatric Pelvic Fractures

A Level I Trauma Center's 20-Year Experience

Michelle B. Mulder, Michael J. Maggart, Wendy J. Yang, Eduardo Perez, Nicholas Namias, Juan E Sola, Kenneth G Proctor, Chad M. Thorson

Research output: Contribution to journalArticle

Abstract

Background: Pediatric pelvic fractures are rare. The contribution of pelvic fracture pattern, risk factors for associated injuries, and mortality are poorly defined in this population. Methods: Patients aged 0-17 with pelvic fractures at a level I trauma center over a 20-y period were reviewed. Fracture patterns were classified according to the Young-Burgess classification when applicable. Fractures were analyzed for location, pubic symphysis or sacroiliac widening, and contrast extravasation. Results: There were 163 pelvic fractures in 8758 admissions (incidence 2%). The most common associated injures were extremity fractures (60%, n = 98), abdominal solid organ (55%, n = 89), and chest (48%, n = 78), with the majority (61%, n = 99) sustaining injuries to multiple organs. Unstable fractures were associated with injures to the thorax (70% versus 40%), heart (15% versus 2%), and spleen (40% versus 18%), all P < 0.05. Nonpelvic operative interventions were required in 45% (n = 73) and were more common in unstable fractures (36% versus 19%), contrast extravasation (63% versus 26%), sacroiliac widening (36% versus 20%), and sacral fractures (39% versus 13%), all P < 0.05. Mortality was 13% and higher in males versus females (18% versus 5%), contrast extravasation (50% versus 3%), or sacroiliac/pubic symphysis widening (13% versus 2%) (all P < 0.05). Male gender (OR 6.03), brain injury (OR 6.18), spine injury (OR 5.06), and cardiac injury (OR 35.0) were independently associated with mortality (all P < 0.05). Conclusions: Pediatric pelvic fractures are rare but critical injuries associated with significant morbidity and need for interventions. Increasing fracture severity corresponds to injuries to other body systems and increased mortality.

Original languageEnglish (US)
Pages (from-to)515-523
Number of pages9
JournalJournal of Surgical Research
Volume243
DOIs
StatePublished - Nov 1 2019
Externally publishedYes

Fingerprint

Trauma Centers
Pediatrics
Pubic Symphysis
Wounds and Injuries
Mortality
Thorax
Multiple Trauma
Brain Injuries
Spine
Spleen
Extremities
Morbidity
Incidence
Population

Keywords

  • Pediatric fractures
  • Pelvic fractures
  • Young burgess

ASJC Scopus subject areas

  • Surgery

Cite this

Outcomes of Pediatric Pelvic Fractures : A Level I Trauma Center's 20-Year Experience. / Mulder, Michelle B.; Maggart, Michael J.; Yang, Wendy J.; Perez, Eduardo; Namias, Nicholas; Sola, Juan E; Proctor, Kenneth G; Thorson, Chad M.

In: Journal of Surgical Research, Vol. 243, 01.11.2019, p. 515-523.

Research output: Contribution to journalArticle

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abstract = "Background: Pediatric pelvic fractures are rare. The contribution of pelvic fracture pattern, risk factors for associated injuries, and mortality are poorly defined in this population. Methods: Patients aged 0-17 with pelvic fractures at a level I trauma center over a 20-y period were reviewed. Fracture patterns were classified according to the Young-Burgess classification when applicable. Fractures were analyzed for location, pubic symphysis or sacroiliac widening, and contrast extravasation. Results: There were 163 pelvic fractures in 8758 admissions (incidence 2{\%}). The most common associated injures were extremity fractures (60{\%}, n = 98), abdominal solid organ (55{\%}, n = 89), and chest (48{\%}, n = 78), with the majority (61{\%}, n = 99) sustaining injuries to multiple organs. Unstable fractures were associated with injures to the thorax (70{\%} versus 40{\%}), heart (15{\%} versus 2{\%}), and spleen (40{\%} versus 18{\%}), all P < 0.05. Nonpelvic operative interventions were required in 45{\%} (n = 73) and were more common in unstable fractures (36{\%} versus 19{\%}), contrast extravasation (63{\%} versus 26{\%}), sacroiliac widening (36{\%} versus 20{\%}), and sacral fractures (39{\%} versus 13{\%}), all P < 0.05. Mortality was 13{\%} and higher in males versus females (18{\%} versus 5{\%}), contrast extravasation (50{\%} versus 3{\%}), or sacroiliac/pubic symphysis widening (13{\%} versus 2{\%}) (all P < 0.05). Male gender (OR 6.03), brain injury (OR 6.18), spine injury (OR 5.06), and cardiac injury (OR 35.0) were independently associated with mortality (all P < 0.05). Conclusions: Pediatric pelvic fractures are rare but critical injuries associated with significant morbidity and need for interventions. Increasing fracture severity corresponds to injuries to other body systems and increased mortality.",
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T2 - A Level I Trauma Center's 20-Year Experience

AU - Mulder, Michelle B.

AU - Maggart, Michael J.

AU - Yang, Wendy J.

AU - Perez, Eduardo

AU - Namias, Nicholas

AU - Sola, Juan E

AU - Proctor, Kenneth G

AU - Thorson, Chad M.

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AB - Background: Pediatric pelvic fractures are rare. The contribution of pelvic fracture pattern, risk factors for associated injuries, and mortality are poorly defined in this population. Methods: Patients aged 0-17 with pelvic fractures at a level I trauma center over a 20-y period were reviewed. Fracture patterns were classified according to the Young-Burgess classification when applicable. Fractures were analyzed for location, pubic symphysis or sacroiliac widening, and contrast extravasation. Results: There were 163 pelvic fractures in 8758 admissions (incidence 2%). The most common associated injures were extremity fractures (60%, n = 98), abdominal solid organ (55%, n = 89), and chest (48%, n = 78), with the majority (61%, n = 99) sustaining injuries to multiple organs. Unstable fractures were associated with injures to the thorax (70% versus 40%), heart (15% versus 2%), and spleen (40% versus 18%), all P < 0.05. Nonpelvic operative interventions were required in 45% (n = 73) and were more common in unstable fractures (36% versus 19%), contrast extravasation (63% versus 26%), sacroiliac widening (36% versus 20%), and sacral fractures (39% versus 13%), all P < 0.05. Mortality was 13% and higher in males versus females (18% versus 5%), contrast extravasation (50% versus 3%), or sacroiliac/pubic symphysis widening (13% versus 2%) (all P < 0.05). Male gender (OR 6.03), brain injury (OR 6.18), spine injury (OR 5.06), and cardiac injury (OR 35.0) were independently associated with mortality (all P < 0.05). Conclusions: Pediatric pelvic fractures are rare but critical injuries associated with significant morbidity and need for interventions. Increasing fracture severity corresponds to injuries to other body systems and increased mortality.

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