Of paramount importance in the evaluation and treatment of pelvic injuries in children is the recognition of the higher likelihood of associated soft organ injury. Given the presence of significantly more cartilage in the pediatric pelvis when compared to that of the adult, the child’s pelvis is much more likely to undergo elastic deformation and recoil, resulting in a much lower rate of true fracture. Unfortunately, the abdominal and pelvic contents are not necessarily protected during such impacts, and are therefore more frequently damaged when compared to similar injuries in adults. As well, head injuries are quite common in these high-energy trauma victims. The presence of a dedicated trauma system is therefore imperative when treating a child that has survived forces sufficient to create pelvic injury.
Most significant pelvic fractures are classified and treated in the same manner as their adult counterparts. The Tile classification system is based on the mechanism of injury, and is the most descriptive. Anterior compression, lateral compression and vertical shear type injuries are all observed in this population. Most of these injuries will be stable, and can be treated non-operatively. Unstable injuries are treated in much the same manner as their adult counterparts, although traction may have a greater role in the pediatric population.
Damage to the triradiate cartilage is unique to this group. Achieving normal acetabular depth and height can thereafter be impeded, and can result in acetabular dysplasia. Late subluxation of the hip can result, and may necessitate pelvic osteotomies.
Avulsion type injuries of one or more of the many pelvic apophyses can also occur in young children. generally, activity modification and protected weight bearing will yield a satisfactory result. Attempts at surgical correction will often lead to abundant callus formation and heterotopic ossification.