Patterns of injury and management of children with pelvic fractures at a non-trauma center

Background: Pelvic injuries in young children are rare, and it has been difficult to establish clinical guidelines to assist providers in managing blunt pelvic trauma, especially in non-Level 1 trauma centers.

Objective: Our aim was to describe the relationship among clinical findings, mechanism of injury, and the radiographic resources utilized in children with pelvic fractures presenting to a non-Level 1 trauma center.

Methods: A retrospective review of patients with a pelvic fracture treated in two urban pediatric Level 3 emergency departments was performed.

Results: Between 2001 and 2010, a total of 208 patients were identified. Avulsion/iliac wing fractures were the most common fractures (58.7%), and sports-related injuries were the most common mechanism of injury (50.0%). Children with sports-related injuries were more likely to sustain an avulsion fracture (p<0.001), less likely to have a computed tomography scan obtained in the emergency department (p<0.001), and less likely to have an associated injury (p<0.001) than other children. Children struck by a motor vehicle (p<0.001) or involved in a motor vehicle accident (p<0.001) were more likely to receive a computed tomography scan (p<0.001) and have associated head and extremity injuries (p<0.001). Mechanism of injury was associated with abnormal computed tomography scans. Nearly all patients were treated nonoperatively (98.1%) and no deaths were reported in this study.

Conclusions: Patterns of injury, based on mechanism of injury, have been reported to assist the assessment and management of children with minor pelvic injuries.