Pediatric pelvic fractures combined with an additional skeletal injury is an indicator of significant injury.

Traumatic fractures of the adult pelvic area have high rates of associated injuries and hemorrhagic complications resulting in significant morbidity and mortality. We studied whether or not the plain roentgenographic identification of other fractures is a reliable marker of increased morbidity and mortality in children with pelvic fractures. The records of 79 children admitted with the diagnosis of pelvic fracture from January 1986 through December 1990 were reviewed. Associated injuries were categorized as head, chest, abdomen or skeletal. The pelvic fractures were grouped using the classification system of Torode. Mechanism of injury, age, weight, vitals on admission, operative procedures performed, amount of blood transfused during the first 24 hours, number of days hospitalized, modified injury severity score (MISS) and revised trauma score (RTS) were recorded for each patient. Using any other bony fracture as an easily identifiable additional risk factor, we recorded the associated injuries in those with pelvic fracture and any additional fracture (PF+AF, n = 39) and pelvic fracture alone (PF, n = 40). The PF+AF group demonstrated a significantly higher incidence of head and abdominal injuries and a significantly higher number of required transfusion in the first 24 hours (Fisher's exact test, p < 0.05). Mortality, thoracic injuries and patients requiring laparotomy or an additional nonorthopedic procedure occurred approximately twice as often in the PF+AF group compared with the PF group. However, the numbers were too small to be statistically significant (Fisher's exact, p > 0.05). The PF+AF group also had a significantly higher MISS and average number of days hospitalized (Student's t test, p < 005). The RTS was significantly lower (p < 0.05). In children with pelvic fractures, we found that any additional bony fracture is a significant marker for head and abdominal injury. This constellation identifies patients who may benefit from early transfer to a regional pediatric trauma center.