PELVIC RING FRACTURES IN CHILDREN - A REP ORT OF 47 CASES

Purpose of the study The aim of this study was to report the different anatomical types, associated injuries, morbidity and mortality of pel vic ring disruption in child in Dakar traumatological centers. Materia l and methods Forty seven children were admitted in two of three traum atology centers in Dakar between 1968 and 1992. This retrospective and intermittent study excluded tendon-bone avulsions and acetabular frac tures. Twenty eight boys and nineteen girls presented a fracture with or without ring disruption according to Ducloyer and filipe classifica tion. In this first group, they make difference between an isolated or combined fracture and distinguished an anterior and a posterior one, Forty five children were treated by a non-operative methods. Results F orty three boys and girls sustained their injuries in a pedestrian-mot or vehicle accidents and 4 among were struck by a truck. A massive fra cture-dislocation with complete pelvic disruption was found in 70,3 pe r cent. Half of them (34,4 per cent) presented an anterior isolated an atomic type, In the other group the high energy forces caused major pe lvic instability and also various associated soft-tissue injuries. The majority of complications were open pelvic fractures (21,1 per cent), genito-urinary (34,4 per cent), vascular (16,6 per cent), neurologica l and perineo-rectal injuries. Four children (8,4 per cent) died. At t he last review others presented orthopaedic, genito-urinary, neurologi cal or perineo-rectal sequelae. Discussion The frequency of pelvic fra ctures in child present a peak between 6 and 12 years old. These types of fractures are the results of a high energy injury in pedestrian mo tor vehicle accidents in Dakar suburbs. The anatdmo-radiographic types had an interesting bimodal pattern. Among the benign types: a double fracture of the iliopubic ramus is dangerous for the bladder (1 case), and leads to a dysplastic acetabulum with time (1 case). Unstable fra ctures (70,3 per cent) : some of them (23,3 per cent) present a comple x dislocation of the pelvis, The present review focuses on double uret hral injuries (2 cases), open pelvic fractures (10 cases) and mortal h emorrhagic shock (4 cases). The morbidity rate is high (38,4 per cent) caused by skeletal and soft-tissue sequelae and also management diffi culties. Conclusion Pelvic fracture in children requires early diagnos is and management. In our countries, morbidity and mortality of these injuries must decrease with the popularization of road safety, multidi sciplinary management and improvement of working conditions.