Skip to main content

Severe pelvic fracture-related bleeding in pediatric patients: does it occur?

European Journal of Trauma and Emergency Surgery volume 38, pages 163–169 (2012)Cite this article

Abstract

Purpose

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Grisoni N, Connor S, Marsh E, Thompson GH, Cooperman DR, Blakemore LC. Pelvic fractures in a pediatric level I trauma center. J Orthop Trauma. 2002;16:458–63.

    PubMed  Article  Google Scholar 

  2. Ismail N, Bellemare JF, Mollit DL, DiScala C, Koeppel B, Tepas JJ 3rd. Death from pelvic fracture: Children are different. J Pediatr Surg. 1996;31:82–5.

    PubMed  Article  CAS  Google Scholar 

  3. Rieger H, Brug E. Fractures of the pelvis in children. Clin Orthop Relat Res. 1997;336:226–39.

    PubMed  Article  Google Scholar 

  4. Silber JS, Flynn JM. Changing patterns of pediatric pelvic fractures with skeletal maturation: implications for classification and management. J Pediatr Orthop. 2002;22:22–6.

    Google Scholar 

  5. Quick TJ, Eastwood DM. Paediatric fractures and dislocations of the hip and pelvis. Clin Orthop Relat Res. 2005;432:87–96.

    Google Scholar 

  6. Blasier RD, McAtee J, White R, Mitchell DT. Disruption of the pelvic ring in pediatric patients. Clin Orthop. 2000;376:87–95.

    PubMed  Article  Google Scholar 

  7. Smith WR, Oakley M, Morgan SJ. Pediatric pelvic fractures. J Pediatr Orthop. 2004;24:130–5.

    PubMed  Article  Google Scholar 

  8. Momiy JP, Clayton JL, Villalba H, Cohen M, Hiatt JR, Cryer HG, Tillou A. Pelvic fractures in children. Am Surg. 2006;72:962–5.

    Google Scholar 

  9. Hauschild O, Strohm PC, Culemann U, Pohlemann T, Suedkamp NP, Koestler W, Schmal H. Mortality in patients with pelvic fractures: results from the German pelvic injury register. J Trauma. 2008;64:449–55.

    Google Scholar 

  10. Teasdale G, Jennet B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;304:81–4.

    Google Scholar 

  11. Tile M, Helfet DL, Kellam JF. Fractures of the pelvis and acetabulum. 3rd ed. Philadephia: Lippincott Williams & Wilkins; 2003.

    Google Scholar 

  12. Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg. 1964;46A:1615–36.

    Google Scholar 

  13. Association for the Advancement of Automotive Medicine. The Abbreviated Injury Scale 2005. http://www.aaam.org.

  14. Baker SP, O′Neill B, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96.

    Google Scholar 

  15. Osler T, Baker SP, Long WB. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma. 1997;43:922–5.

    PubMed  Article  CAS  Google Scholar 

  16. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the trauma score. J Trauma. 1989;29:623–9.

    PubMed  Article  CAS  Google Scholar 

  17. Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. J Trauma. 1987;27:370–8.

    Google Scholar 

  18. Skaga NO, Eken T, Steen PA. Assessing quality of care in a trauma referral center: benchmarking performance by TRISS-based statistics or by analysis of stratified ISS data? J Trauma. 2006;60:538–47.

    Google Scholar 

  19. Strauss RG, Hillyer CD, Luban NLC, editors. Handbook of pediatric transfusion medicine. San Diego: Academic; 2004.

  20. Demetriades D, Karaiskakis M, Velmahos GC, Alo K, Murray J, Chan L. Pelvic fractures in pediatric and adult trauma patients: are they different injuries? J Trauma. 2003;54:1146–51.

    Google Scholar 

  21. Statistics Finland. Website. http://www.stat.fi.

Download references

Conflict of interest

None.

Author information

Affiliations

  1. Department of Orthopedics and Traumatology, Töölö Hospital, Helsinki University Central Hospital, Topeliuksenkatu 5, P.O. Box 00029, Helsinki, Finland

    H. Tuovinen, T. Söderlund, J. Lindahl, P. Åström & L. Handolin

  2. Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland

    T. Laine

Authors
  1. H. Tuovinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Söderlund
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Lindahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. Laine
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Åström
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. Handolin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Handolin.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Tuovinen, H., Söderlund, T., Lindahl, J. et al. Severe pelvic fracture-related bleeding in pediatric patients: does it occur?. Eur J Trauma Emerg Surg 38, 163–169 (2012). https://doi.org/10.1007/s00068-011-0140-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-011-0140-3

Keywords

  • Acetabulum fracture
  • Pelvic fracture
  • Pediatric trauma
  • Massive bleeding
  • Mortality
  • Epidemiology