Commonly caused by automobile-pedestrian accidents, pelvic fractures in children have a high incidence of concomitant injuries because of the smaller protection afforded by the developing pelvis and the significant trauma incurred.14 Hemorrhage determines mortality. Children in shock who respond poorly to fluid replacement have the highest mortality. Frequent concomitant injuries include head and neck injuries, intra-abdominal injuries, and long bone fractures. The incidence of genitourinary injuries is similar to that of adults. Major thoracic injuries are rare but particularly dangerous because they are often overlooked.
Postponement of surgery until stabilization of circulation is recommended unless the patient is exsanguinating despite treatment. If the child does not respond to transfusions equal to the estimated total blood volume (TBV) (88 mL/kg * wt [kg] = TBV) within 1 h, suspect major vascular injury and operate. Both arterial and venous injuries are associated with significant SI joint injury.
Except for pelvic avulsion fractures, early orthopedic consultation and hospitalization is indicated. Surgical treatment for pelvic fractures is indicated less frequently in children than in adolescents or adults because of children's ability to remodel pelvic fractures and because early ambulation is not critical. 14 Nondisplaced fractures can generally be treated with bedrest alone. Displaced fractures can be treated with distal femoral skeletal traction on the displaced side of the hemipelvis. Severely malaligned Malgaigne fractures may occasionally require open reduction and internal fixation.
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