Mh. Sy et al., PELVIC RING FRACTURES IN CHILDREN - A REP ORT OF 47 CASES, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur, 81(6), 1995, pp. 538-545
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.