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Beckenverletzungen im Kindes- und Jugendalter

Eine retrospektive Analyse eines überregionalen Traumazentrums über 5 Jahre

Pelvic injuries in childhood and adolescence

Retrospective analysis of 5-year data from a national trauma centre

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Zusammenfassung

Hintergrund

Beckenfrakturen sind aufgrund der anatomischen Besonderheiten bei Kindern selten. Aufgrund der geringen Inzidenz existieren keine einheitlichen Therapiealgorithmen.

Material und Methode

Diese retrospektive Datenanalyse untersucht Kinder eines 5-Jahres-Zeitraums mit einer Beckenverletzung und vergleicht die Ergebnisse mit dem Erwachsenkollektiv sowie mit der Fachliteratur. Insgesamt konnten 37 Patienten (≤16 Jahre) erfasst werden, dies entspricht einer Inzidenz von 9,9% beim polytraumatisierten Kind. Als Unfallursache standen Verkehrsunfälle im Vordergrund, gefolgt von Stürzen aus großer Höhe.

Ergebnisse

In 50% lag eine Typ-A-Verletzung vor (Typ B: 16%, Typ C: 27%, Acetabulumfrakturen: 11%). Eine operative Stabilisierung wurde in 9 Fällen durchgeführt. In 3 Fällen lag eine interventionspflichtige hämodynamisch relevante Blutung vor. Begleitverletzungen wurden bei 97% der Kinder beobachtet (mittlerer „Injury Severity Score“: 38).

Schlussfolgerung

Es konnten z. T. Unterschiede zu den Ergebnissen anderer Untersuchungen beobachtet werden. Dabei stellt die Beckenverletzung beim polytraumatisierten Kind einen Marker für eine hohe Verletzungsschwere dar. Im Vergleich zum Erwachsenen kann trotz ähnlichem Frakturmuster in der Mehrzahl der Fälle eine konservative Therapie durchgeführt werden. Bei dislozierten, instabilen Verletzungen besteht die Indikation zur anatomischen Reposition und Osteosynthese.

Abstract

Background

Pelvic fractures are uncommon injuries in paediatric trauma patients because of specific anatomical features. Due to the low incidence there is no standardized therapeutic algorithm.

Material and methods

This retrospective review evaluates paediatric pelvic fractures of a Level I Trauma Centre over 5 years. In addition, we compared the data with adult pelvic fractures and reviewed the literature. A total of 37 pelvic fractures (≤16 years) were documented, with an incidence of 9.9% in the child with multiple injuries. The most common injury mechanisms were traffic accidents, followed by falls from heights.

Results

Type A injuries occurred in 50% (type B: 16%, type C: 27%, acetabular injuries: 11%). Osteosynthesis was performed in nine cases. Therapeutic intervention was necessary in three cases of haemodynamically relevant bleeding; 97% of all children had associated injuries (mean ISS: 38).

Conclusion

Our data showed some differences to the literature. Pelvic fractures are predictors for high injury severity. Despite similar fracture pattern, in contrast to adults most injuries could be treated non-operatively. In unstable or dislocated fractures open reduction and stabilization must be performed.

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Authors and Affiliations

  1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland

    D. Schneidmueller, S. Wutzler, A. Kelm, H. Wyen, F. Walcher & I. Marzi

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  1. D. Schneidmueller
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  2. S. Wutzler
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  3. A. Kelm
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Correspondence to D. Schneidmueller.

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Schneidmueller, D., Wutzler, S., Kelm, A. et al. Beckenverletzungen im Kindes- und Jugendalter. Unfallchirurg 114, 510–516 (2011). https://doi.org/10.1007/s00113-010-1918-1

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  • DOI: https://doi.org/10.1007/s00113-010-1918-1

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