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

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

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.

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%.

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.