title: Pediatric pelvic ring injuries: How benign are they?
abstract: BACKGROUND
  With an incidence of less than 0.2% of all pediatric fractures, pelvic ring injuries are rare. Historically they were conservatively treated, but because malunion and long-term morbidity are associated with unstable injuries, a trend towards operative treatment can be observed. The purpose was to determine clinical and radiographic outcomes following these complex pediatric pelvic ring injuries.
  
  
  METHODS
  This Level IV retrospective analysis was completed at a private orthopaedic practice in association with a Level One teaching trauma center. There were 33 children with pelvic ring injuries with a mean age of 12.6 years (4-16) and an average follow up of 28.6 months (range 6-101). Injuries were 2 A2, 3 B1, 16 B2, 10 B3, and 2 C2 according to OTA/AO classification. Group 1 had 16 unstable, operatively treated injuries and Group 2 had 17 stable, non-operatively treated injuries. Radiographic deformity, leg length discrepancy, low back, and SI joint pain were evaluated.
  
  
  RESULTS
  For Group 1, 10 of 15 patients (67%) had a permanent ischial height difference >5mm compared to Group 2, in which 5 of 12 (42%) had an ischial height difference of >5mm. Group 1 had more pelvic asymmetry (12.3mm vs. 6.6mm) and ring width difference (6.9mm vs. 3.9mm) on final X-rays as compared to Group 2. Children with 5-10mm posterior sacral displacement had significantly more pain than children with 0-4mm displacement (p=0.034). Thirteen children (39%) had residual low back/SI joint pain; the rate was significantly higher in the Group 1 (3/17 vs. 10/16, p=0.008). In three (9%) children with 2 B2 and 1 B3 injury, leg length discrepancy between 5mm to 15mm occurred.
  
  
  CONCLUSIONS
  In pediatric patients with pelvic ring injuries, radiographic deformity persisted and did not remodel. Pelvic ring deformity occurred more commonly with complex unstable ring injuries. The complex displaced injuries have higher rates of operative intervention, residual deformity, and low back and SI joint pain.
authors.affiliation: Grand Rapids Medical Education Partners, Grand Rapids, MI, USA; Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany. Electronic address: Christiane.Kruppa@ruhr-uni-bochum.de.
authors.forename: Christiane G
authors.initials: CG
authors.lastname: Kruppa
authors.affiliation: Michigan State University, Grand Rapids, MI, USA.
authors.forename: Justin D
authors.initials: JD
authors.lastname: Khoriaty
authors.affiliation: The CORE Institute(®), Center for Orthopedic Research and Education, University of Arizona, College of Medicine, Phoenix, USA.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Sietsema
authors.affiliation: Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany; Department of Orthopaedics and Trauma Surgery, University Hospital Essen, Germany.
authors.forename: Marcel
authors.initials: M
authors.lastname: Dudda
authors.affiliation: Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Schildhauer
authors.affiliation: The CORE Institute(®), Center for Orthopedic Research and Education, Banner Musculoskeletal Institute Center Chiefs for Orthopedic Trauma and Bone Health, University of Arizona, College of Medicine, Phoenix, USA.
authors.forename: Clifford B
authors.initials: CB
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D007870:Leg Length Inequality / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D009104:Multiple Trauma / Q000601:surgery*; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D014193:Trauma Centers; D015599:Trauma Severity Indices; D016896:Treatment Outcome
keywords: Deformity; Instability; Pain; Pediatric fractures; Pelvic ring