synonyms: Pediatric Pelvic ring injury, Pediatric Pelvic fracture, Pediatric Pelvic ring disruption
Pediatric Pelvic Ring Injury ICD-10
A- initial encounter for closed fracture
B- initial encounter for open fracture
D- subsequent encounter for fracture with routine healing
G- subsequent encounter for fracture with delayed healing
K- subsequent encounter for fracture with nonunion
Pediatric Pelvic Ring Injury ICD-9
- 808.43 (multiple with disruption of Pediatric Pelvic circle, closed)
- 808.53 (multiple with disruption of Pediatric Pelvic circle, open)
- 808.41 (ilium closed)
- 808.51 (ilium open)
- 808.42 (ischium closed)
- 808.52 (ischium open)
- 808.2 (pubis closed)
- 808.3 (pubis open)
Pediatric Pelvic Ring Injury Etiology / Epidemiology / Natural History
- Generally MVC or MVC vs pedestrian injuries.
- Lateral compression injuries are sustained by direct lateral force to the iliac wing leading to internal rotation deformity of the affected hemipelvis.
Pediatric Pelvic Ring Injury Anatomy
- Triradiate cartilage closes 12.5yrs in girls and 13.5 years in boys.
Pediatric Pelvic Ring Injury Clinical Evaluation
- ATLS resuscitation. These can be high enegery injuries, assessment should begin with the A,B,C's.
- Gently inspect iliac crests for instability, inspect perineum, during log role evaluate for open injuries.
- Document bilateral LE neurovascular exam
- Rectal exam: evaluate for blood, high riding prostate.
Pediatric Pelvic Ring Injury Xray / Diagnositc Tests
Pediatric Pelvic Ring Injury Classification / Treatment
- Young, Burgess Classification J Trauma 30:848;1990
- non-op treatment (Henderson RC, J Orthop Trauma 3:41;1989)
- Anteroposterior Compression(diastasis of the symphysis and scroiliac joints): >2,5cm of diastasis whoudl be reduced and fixed with internal or external fixation.
- Lateral Compression, <1cm posterior displacement, no neurologic deficit:
Treatment: NWB until fracture union
- Lateral Compression, >1cm posterior displacement, or neurologic deficit:
Treatment: Consider skeletal traction if pelvis is cranially displaced. ORIF / Sacral screws Pelvic Ring.
- Pregnancy and Pediatric Pelvic ring injury: (Pape JC, JOT 2000;14:238).
- Document discussion of DVT risk and prophylaxis options in the medical record. Generally prophylaxis is provided with sequential compression devices prior to surgery and warfarin or low molecular weight heparin post-operatively.
- ORIF Pediatric Pelvic Ring
- Pelvic External Fixation
Pediatric Pelvic Ring Injury Associated Injuries / Differential Diagnosis
- Retroperitoneal venous bleeding
- Pelvic arterial bleeding
- Thoracic trauma
- Intra-abdominal injury
- Extremity fractures
- Urologic injury
- Sexual dysfunction
Pediatric Pelvic Ring Injury Complications
- Poor wound healing
- Chronic Osteomyelitis
- Acetabular undergrowth
- Painful hardware
- Loss of reduction
- Limb length discrepancy
- Sitting imbalance
- Gait disturbance
- DVT / PE (Borer DS, JOT 2005;19:92).
Pediatric Pelvic Ring Injury Follow-up Care
- Early mobilization to an upright position is key to reducing morbidity and mortality.
- Post-op: 24hrs antibiotic, SCDs, Ted hose, Partial weight bearing. Review reduction on post op A/P pelvis, inlet and outletviews.
- 7-10 Days: Wound check. Continue partial/non weight bearing
- 6 Weeks: Advance weight bearing gradually. Review A/P pelvis, inlet and outletviews.
- 3 Months: Review A/P pelvis, inlet and outletviews.
- 6 Months: Return to labor. Review reduction on post op A/P pelvis, inlet and outletviews. Obtain follow-up CT scan.
- 1Yr:Assess outcome. Review A/P pelvis, inlet and outlet views.
Pediatric Pelvic Ring Injury Review References