title: Severe pelvic fracture-related bleeding in pediatric patients: does it occur?
abstract: OBJECTIVE
  Pediatric pelvic fractures are rare and less likely to cause hemodynamic instability than similar injuries in adult patients. The associated injuries are common, and they have a major impact on mortality. The aim of the present study was to evaluate the risk of life-threatening hemorrhage associated with unstable pelvic fractures in children.
  
  
  METHODS
  We identified retrospectively all pediatric pelvic fractures (ring and acetabulum) treated at Helsinki University Central Hospital during a 10-year period (1998-2007). Stable A-type fractures (fractures not involving the pelvic ring) were excluded. All available pre- and in-hospital medical records were reviewed. The collected data consisted of patient characteristics, mechanisms of injury, vital signs, laboratory tests, care given, other injuries diagnosed, and the 30-day survival rate.
  
  
  RESULTS
  There were 71 (40 males) pediatric patients (median age 14, range 1-16 years) with unstable pelvic fractures; 66 pelvic ring and 5 acetabulum fractures. The most common mechanism of injury was traffic accident (69%). Four patients had life-threatening bleeding. All had fracture of a mature pelvic ring, but the source of massive bleeding was pelvic ring fracture in only two patients (2.8% of all patients). No acetabulum fracture-related major pelvic bleeding was observed. One patient (age 16 years) required emergency surgery and angioembolization for pelvic bleeding. No life-threatening pelvic bleeding was seen among patients with immature bony pelvis. Pelvic ring fractures were surgically treated in 25 patients. Two patients died from head injuries (overall mortality 2.8%), but there were no bleeding-related deaths.
  
  
  CONCLUSIONS
  We conclude that life-threatening bleeding from pelvic or acetabular fractures in pediatric patients is rare (2.8%), and does not contribute to the overall mortality.
authors.affiliation: Department of Orthopedics and Traumatology, Töölö Hospital, Helsinki University Central Hospital, Topeliuksenkatu 5, P.O. Box 00029, Helsinki, Finland.
authors.forename: H
authors.initials: H
authors.lastname: Tuovinen
authors.affiliation: Department of Orthopedics and Traumatology, Töölö Hospital, Helsinki University Central Hospital, Topeliuksenkatu 5, P.O. Box 00029, Helsinki, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Söderlund
authors.affiliation: Department of Orthopedics and Traumatology, Töölö Hospital, Helsinki University Central Hospital, Topeliuksenkatu 5, P.O. Box 00029, Helsinki, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Lindahl
authors.affiliation: Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Laine
authors.affiliation: Department of Orthopedics and Traumatology, Töölö Hospital, Helsinki University Central Hospital, Topeliuksenkatu 5, P.O. Box 00029, Helsinki, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Åström
authors.affiliation: Department of Orthopedics and Traumatology, Töölö Hospital, Helsinki University Central Hospital, Topeliuksenkatu 5, P.O. Box 00029, Helsinki, Finland. lauri.handolin@hus.fi.
authors.forename: L
authors.initials: L
authors.lastname: Handolin
keywords: Acetabulum fracture; Epidemiology; Massive bleeding; Mortality; Pediatric trauma; Pelvic fracture
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