title: Surgical treatment for unstable pelvic fractures in skeletally immature patients.
abstract: OBJECTIVE
  To present the results and conclusions of our study on surgical treatment for unstable pelvic fractures in children subjected to surgical reduction and stabilisation.
  
  
  METHODS
  We analysed the cases of fourteen skeletally immature patients with unstable pelvic fractures who underwent surgery for this condition between March 2004 and January 2011. The surgical technique used was based on the principle of surgical reduction and stabilisation of anterior and posterior lesions of the pelvic ring. This was a retrospective study, based on clinical assessment and X-ray analyses.
  
  
  RESULTS
  The mean age of patients at the time of the condition was 9.4 years (range 2-13 years). Eight patients were female and six were male. The cause of the trauma was being hit by a car in ten cases, falls in three cases and an accident involving a motorcycle in one case. Five patients presented with other associated injuries, including fracture of the clavicle, femur shaft, proximal humerus, tibial shaft or olecranon, and bladder damage. All the patients assessed showed excellent clinical progress. Pelvic asymmetry prior to surgery varied from 1.1 to 2.9 cm (mean 1.5 cm) and dropped to a range of 0.2 to 0.9 cm (mean 0.4 cm) after reduction. In none of the cases was there a change between the pelvic asymmetry measured immediately after surgery and at the end of the follow-up period.
  
  
  CONCLUSIONS
  Pelvic fracture in skeletally immature patients is rare and surgery is not normally indicated. Various authors have questioned this conservative type of treatment due to complications encountered. Bone remodelling does not seem to be sufficient to ensure an improvement in pelvic asymmetry, which justifies opting for surgery to reduce and correct deformities in the pelvic ring.
authors.affiliation: National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil. Electronic address: jomatheus@uol.com.br.
authors.forename: Joao Antonio Matheus
authors.initials: JA
authors.lastname: Guimarães
authors.affiliation: National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil.
authors.forename: Pedro Henrique B
authors.initials: PH
authors.lastname: Mendes
authors.affiliation: National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil.
authors.forename: Frederico C M
authors.initials: FC
authors.lastname: Vallim
authors.affiliation: National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil.
authors.forename: Leonardo R
authors.initials: LR
authors.lastname: Rocha
authors.affiliation: National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil.
authors.forename: Tito H N
authors.initials: TH
authors.lastname: Rocha
authors.affiliation: Department of Health Science Post-Graduate Studies at the Federal Fluminense University, Rio de Janeiro, Brazil.
authors.forename: Isabel Cristina C
authors.initials: IC
authors.lastname: do Val
authors.affiliation: National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil.
authors.forename: Maria Eugenia L
authors.initials: ME
authors.lastname: Duarte
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D020127:Recovery of Function; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Children; Pelvic asymmetry; Pelvic ring; Reduction; Skeletally immature patients; Stabilisation; Unstable pelvic fracture