Unstable paediatric pelvic injuries: the patho-anatomical patterns of pelvic ring failure and the role of avulsion of the iliac apophysis.
Unstable pelvic injuries in young children with an immature pelvis have different modes of failure from those in adolescents and adults. We describe the pathoanatomy of unstable pelvic injuries in these children, and the incidence of associated avulsion of the iliac apophysis and fracture of the ipsilateral fifth lumbar transverse process (L5-TP). We retrospectively reviewed the medical records of 33 children with Tile types B and C pelvic injuries admitted between 2007 and 2014; their mean age was 12.6 years (2 to 18) and 12 had an immature pelvis. Those with an immature pelvis commonly sustained symphyseal injuries anteriorly with diastasis, rather than the fractures of the pubic rami seen in adolescents. Posteriorly, transsacral fractures were more commonly encountered in mature children, whereas sacroiliac dislocations and fracture-dislocations were seen in both age groups. Avulsion of the iliac apophysis was identified in eight children, all of whom had an immature pelvis with an intact ipsilateral L5-TP. Young children with an immature pelvis are more susceptible to pubic symphysis and sacroiliac diastasis, whereas bony failures are more common in adolescents. Unstable pelvic injuries in young children are commonly associated with avulsion of the iliac apophysis, particularly with displaced SI joint dislocation and an intact ipsilateral L5-TP.
Sohag University Hospital, 82524 Sohag, Egypt.
M
M
Kenawey
Hannover Medical School (MHH), 30625 Hannover, Germany.
C
C
Krettek
Sohag University Hospital, 82524 Sohag, Egypt.
A
A
Addosooki
Sohag University Hospital, 82524 Sohag, Egypt.
W
W
Salama
Hannover Medical School (MHH), 30625 Hannover, Germany.
E
E
Liodakis
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000473:pathology*; D006801:Humans; D007085:Ilium / Q000293:injuries; D008297:Male; D010384:Pelvic Bones / Q000293:injuries* / Q000473:pathology*; D012189:Retrospective Studies
Iliac apophysis avulsion; Paediatric pelvic trauma; Pelvic ring injuries