Igboechi Oduche, Purtell Sarah R, Carry Patrick, Sanders Julia S
Department of Orthopedics, University of Maryland School of Medicine, Baltimore, MD.
Children's Hospital Colorado, Musculoskeletal Research Center.
J Pediatr Orthop. 2023 Aug 1;43(7):424-430. doi: 10.1097/BPO.0000000000002426. Epub 2023 May 3.
Existing classification systems may not adequately describe the injury patterns seen pelvic ring and acetabular fractures in the skeletally immature population. Pediatric patients, once stabilized, are often transferred for these injuries. We evaluated which commonly used systems correlate with clinical management in pediatric patients, including transfer patterns based on injury severity.
A retrospective review of patients aged 1 to 15 treated for traumatic pelvic or acetabular fractures over a 10-year period at an academic level I Pediatric Trauma Center reviewed demographic, radiographic, and clinical data.
A total of 188 pediatric patients (average age 10.1 y) were included. Increasing injury severity based on classification Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA P <0.001; Young and Burgess P <0.001; Torode/Zieg P <0.001), increasing Injury Severity Score ( P =0.0017), and decreasing hemoglobin levels ( P =0.0144) were significantly associated with operative management. Injury characteristics did not differ between patients who were transferred versus patients who were brought in directly from the field. Air transport was significantly associated with surgical treatment, pediatric intensive care unit admission, polytrauma, and Torode/Zieg classification ( P =0.036, <0.0001, 0.0297, 0.0003, respectively).
Although not fully descriptive of skeletally immature fracture patterns, the AO/OTA and Young and Burgess classification systems adequately assess the severity of pelvic rings and injuries in pediatric patients and predict management patterns. The Torode and Zieg classification also predicts management. In a large cohort, air transport was significantly associated with surgical treatment, need for pediatric intensive care unit stay, the presence of an additional injury, and instability in the Torode and Zieg classification. These findings suggest that air transfers are being utilized to expedite advanced-level care in more severe injuries. Further studies with long-term follow-up are required to assess the clinical outcomes of both nonoperatively and operatively treated pediatric pelvic fractures and to guide both triage and treatment decisions for these rare but severe injuries.
Level III.
现有的分类系统可能无法充分描述骨骼未成熟人群中骨盆环和髋臼骨折的损伤模式。儿科患者一旦病情稳定，常因这些损伤而被转运。我们评估了哪些常用系统与儿科患者的临床管理相关，包括基于损伤严重程度的转运模式。
对一家一级学术儿科创伤中心10年间治疗的1至15岁创伤性骨盆或髋臼骨折患者进行回顾性研究，回顾人口统计学、影像学和临床数据。
共纳入188例儿科患者（平均年龄10.1岁）。基于 Arbeitsgemeinschaft für Osteosynthesefragen/骨科创伤协会（AO/OTA）分类、Young和Burgess分类、Torode/Zieg分类，损伤严重程度增加（P<0.001），损伤严重度评分增加（P = 0.0017），血红蛋白水平降低（P = 0.0144）与手术治疗显著相关。转运患者与直接从现场送来的患者的损伤特征无差异。空中转运与手术治疗、儿科重症监护病房收治、多发伤和Torode/Zieg分类显著相关（分别为P = 0.036、<0.0001、0.0297、0.0003）。
尽管AO/OTA、Young和Burgess分类系统不能完全描述骨骼未成熟骨折模式，但能充分评估儿科患者骨盆环损伤的严重程度并预测管理模式。Torode和Zieg分类也能预测管理情况。在一个大型队列中，空中转运与手术治疗、儿科重症监护病房住院需求、合并其他损伤以及Torode和Zieg分类中的不稳定性显著相关。这些发现表明，空中转运被用于加快对更严重损伤的高级护理。需要进行长期随访的进一步研究，以评估非手术和手术治疗的儿科骨盆骨折的临床结果，并指导对这些罕见但严重损伤的分诊和治疗决策。
三级。
