Pediatric pelvic fracture:  a modification of a preexisting classification.
BACKGROUND
The classic pediatric pelvic fracture (PPF) classification was developed by Torode and Zeig in 1985 and is based exclusively on plain radiographs. The purpose of this study was to propose a modification to a previously accepted PPF classification scheme and discuss the significance of this modification with respect to treatment and management of PPF over an 8-year period at a large pediatric hospital.


METHODS
PPFs were recorded on a prospectively identified hospital registry of all trauma admissions. Pelvic x-rays and computerized tomography scans were reviewed and classified according to a modified classification scheme. Correlation was made with age, sex, mechanism, associated injuries, intensive care unit stay, operations, and discharge outcome. Blood product usage was obtained from a hematology database.


RESULTS
A total of 124 children were identified with PPF, comprising 1.6% of trauma admissions between July 2000 and June 2008. Radiology was available for 115 children (58 boys, and 57 girls, mean age 11.5 y). According to the modified classification, 71% (82/115) had type III-A or III-B injuries (type I=5 children, type II=17 children, type IV=11 children). There was a mortality of 5% (6/115 children) during the study. Eighty-one percent (93/115) of PPF resulted from being involved in a motor vehicle accident (occupant or pedestrian). Trend testing showed relationships between increasing fracture type and length of stay (P<0.001), as well as the need for blood transfusion (P=0.009) or pelvic operation (P<0.001). A total of 34 (30%, 34/115) children required blood products. Type III-B injuries were more likely to receive blood products than type III-A injuries (odds ratio 3.58; 95% confidence interval, 1.28-10.03).


CONCLUSIONS
: The modified Torode PPV classification is predictive for significant morbidity and death in the setting of multitrauma. Stable type III-B fractures are indicative of increased blood product use, intensive care unit requirement, and overall hospital stay. This modified classification scheme will aid health care providers at all levels in managing PPF more efficiently during their initial resuscitation and treatment period.


METHODS
Level III-retrospective case control study.
Department of Orthopaedics, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA. benjamin.shore@childrens.harvard.edu
Benjamin J
BJ
Shore
Cameron S
CS
Palmer
Catherine
C
Bevin
Michael B
MB
Johnson
Ian P
IP
Torode
D000063:Accidents, Traffic; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000145:classification* / Q000150:complications; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D009104:Multiple Trauma; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D012042:Registries; D014057:Tomography, X-Ray Computed