Ministry of Health

http://newzealand.govt.nz/

    
 ©Copyright
 Published: 28/11/2011

Pelvic Fractures and associated injuries
Bhavesh Patel

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Outline

Pelvic fractures and associated injuries; Starship Experience
Bhavesh Patel
Starship Children’s Hospital

Introduction
• 2.5 – 7.5% of blunt abdo trauma
• 9 year retrospective review
• 84 cases
• Mechanism, classification and associated injuries

Comparison Studies
• Chia 2004, Sydney
• Silber 2001, Philadelphia
• Lane-O’Kelly 1995, Ireland
• Reiger 1997, Germany

Ped vs Car

Wear a seat belt!

Mechanism

• Ride-on lawnmower
• Fell off mini-train
• Boogyboarding on sand-dunes
• Non-accidental injury
“Other Injuries”

Mechanism Child vs Adult

Mechanism

Classification

• Key and Conwell
– Kane modification 1975
• Letournel 1980
• Bucholz 1982
• Tile 1983
• Torode and Zeig 1985
• Young and Burgess 1986
 

Fractures vs Associated Injury

Predictors of
associated injury

• Multiple fractures of the ring
– Associated with higher abdo/GU injury

• Geometry of fracture
– Predicts risk of haemorrhage
Associated Injuries

Mortality
• 6 patients (7%)
• 5 severe head injury
• ped vs car
• 1 multiorgan failure
• RTC passenger

Mortality
• Starship 7%
• Sydney 4%
• Philadelphia 3.6%

Management of Pelvic #
• 92% conservatively managed
• 94% Sydney, 97% Philadelphia
• 7 patients had interventions
– 3 ex fix
– 3 acetabular # (ORIF)
– 1 MUA + hip wash

Adult vs Child
• Adult > Child ~2:1
• Mechanism
• Role of fracture vs associated injury
• Mortality rate and cause

Pennsylvania Trauma Outcome Study*
• Early functional outcomes
• FIM score (functional independent measurement)
– Feeding
– Transfer mobility
– Locomotion
– Expression
– Social interaction

Functional Outcome Study
conclusions
• Short term function significantly impaired in a high percentage of children
• More FIM studies for long term morbidity required
• Aggressive rehabilitation program required

Conclusion
• ↑ fracture complexity = ↑ associated injury
• Children die from associated injuries
• Similar figures around the world
• Long term outcome