Purpose:
Pediatric pelvic fractures are rare and less likely to cause hemodynamic instability than similar injuries in adult patients. the associated injuries are common, and they have a major impact on mortality. the aim of the present study was to evaluate the risk of life-threatening hemorrhage associated with unstable pelvic fractures in children.
Methods:
We identified retrospectively all pediatric pelvic fractures (ring and acetabulum) treated at helsinki university central hospital during a 10-year period (1998-2007). stable a-type fractures (fractures not involving the pelvic ring) were excluded. all available pre- and in-hospital medical records were reviewed. the collected data consisted of patient characteristics, mechanisms of injury, vital signs, laboratory tests, care given, other injuries diagnosed, and the 30-day survival rate.
Results:
There were 71 (40 males) pediatric patients (median age 14, range 1-16 years) with unstable pelvic fractures; 66 pelvic ring and 5 acetabulum fractures. the most common mechanism of injury was traffic accident (69%). four patients had life-threatening bleeding. all had fracture of a mature pelvic ring, but the source of massive bleeding was pelvic ring fracture in only two patients (2.8% of all patients). no acetabulum fracture-related major pelvic bleeding was observed. one patient (age 16 years) required emergency surgery and angioembolization for pelvic bleeding. no life-threatening pelvic bleeding was seen among patients with immature bony pelvis. pelvic ring fractures were surgically treated in 25 patients. two patients died from head injuries (overall mortality 2.8%), but there were no bleeding-related deaths.
Conclusions:
We conclude that life-threatening bleeding from pelvic or acetabular fractures in pediatric patients is rare (2.8%), and does not contribute to the overall mortality.