The Spectrum of Pediatric Pelvic Fractures: A Multi-Center Study from the APSA Office of Outcomes and Clinical Trials

Andrea L Winthrop MD, Ana Krishnan MPH, Marchelle Werner BS, Steven Stylianos MD, Keith T. Oldham MD, Michael G Vitale MD, David Mooney MD and Arthur Cooper MD. APSA Office of Outcomes and Clinical Trials, APSA, Chicago, Illinois, United States

Purpose:
To evaluate the spectrum of pelvic fractures, and examine variability in clinical management, morbidity and functional outcomes utilizing a multi-center pediatric hospital network.

Methods:
Data collected retrospectively for 1999 on 240 children from 20 institutions included clinical management, injury severity, associated injuries, in-hospital morbidity, functional outcome and long-term follow-up.

Results:
The mean age was 9.2 years, with a mean ISS of 16.7. Sixty-nine percent of injuries were motor-vehicle related. Seventy percent had associated injuries, including 8.5% with bladder or urethral injuries. Only 21% required transfusion. The mean length of stay (LOS) was 7 days, and mean LOS ICU was 3.3 days. Twenty-three percent had unstable fractures, and these were more likely to require transfusion, and have a longer LOS. Only 10% had operative intervention. The use of fixation was variable, and timing and type of fixation did not correlate with stability of the fracture.

  Stable Fracture Unstable Fracture
Internal Fixation (N=23) 44% 56%
External Fixation (N=14) 50% 50%

The median time for ambulating with assistance and without assistance was 3 and 4 days respectively, but significantly longer in patients with unstable fractures or associated injuries. The FIM™ scores at discharge were available in 56/240 patients, and demonstrated significant disability at discharge. FIM™ scores and follow-up outcome information beyond discharge was minimal. Seventy percent were discharged home, 9.5% home with nursing care, and 15.5% to rehabilitation or nursing facilities. Overall mortality was 5.5%.

Conclusion:
Our data suggest that pelvic fractures in children are associated with minimal in-hospital morbidity. There appears to be a significant variability in orthopedic management of the fracture, and it is not clear whether this impacts on outcome. FIM™ scores after discharge and other long-term follow-up data is scarce. This study has been the impetus for initiation of a prospective study examining functional status and quality of life after discharge from hospital.