Early functional outcome in children with pelvic fractures

Background/Purpose: Although the mortality, morbidity, and spectrum of asso ciated injuries in children with pelvic fractures have been extensively stu died, little is known a bout the functional outcomes in these patients. The authors examined retrospectively functional independence measurement (FIM) at discharge in children with pelvic fractures to determine how it should influence their management protocol. Methods: The authors reviewed the records of all patients who sustained pel vic fractures between 1993 and 1998 in the trauma registry of a lever I ped iatric trauma center. Patients were stratified according to demographics, t ype of pelvic fracture, functional independence measurement, and discharge disposition. Fractures graded 1, 2, or 3 were defined as stable, whereas gr ade 4 fractures were deemed unstable. Results: A total of 88 children sustained pelvic fractures. Seventy-four pe rcent had stable fractures, whereas 26% sustained unstable fractures. There was no difference in age or sex between the groups; boys were more commonl y injured than girls. Motor vehicle-related crashes accounted for most inju ries. The mean injury severity score (ISS) for patients with a stable fract ure was 17 +/- 14 and 20 +/- 13 for unstable fractures. There was no differ ence in overall hospitalization nor intensive care unit stay between the un stable and stable fracture patients. Eighty percent of the patients with un stable and 52% of the patients with stable pelvic fractures were dependent based on locomotion, and similar proportions were seen for the transfer cat egory. Conclusions: Short-term function appears to be significantly impaired in a high percentage of children with stable and unstable pelvic fractures. Ther efore, aggressive rehabilitation should be instituted early in all children with pelvic fractures to achieve optimal functional outcome. Copyright (C) 2000 by W.B. Saunders Company.