Pelvic fractures in children--review of 120 patients with a new look at general management.

Retrospective analysis of 120 pelvic fractures in children revealed many differences from reports of this injury in adults. Most of the children injured are pedestrians. Ruptured urethra and bladder are less commonly associated with pelvic fractures in children. Associated head injury with residual neurologic deficits are more common in children. Mortality in adults is approximately 10%, while in children it is about 5%. The mortality in our series was 1.4%, the lowest reported in the literature. The rectal examination is a most important part of the physical evaluation, IVP and cystourethogram are necessary in distinguishing serious genitourinary injuries (10%) when hematuria is present (57%) and are also helpful in evaluating retroperitoneal hematoma. Retroperitoneal hemorrhage and secondary infection are the main causes of death in children and adults with pelvic fractures. Although recognizable retroperitoneal hematomas were present in 46% of our patients, only 3% of these children had continuing massive retroperitoneal hemorrhage requiring intervention. Initial arteriography is valuable in management of children with continuing bleeding and large retroperitoneal hematomas. A new technique, silicone balloon embolization, may be combined with selective arteriography to occlude bleeding arteries. This was invaluable in two of our patients; hemorrhage from the hypogastric arteries, was successfully arrested in both cases. We believe this technique deserves more evaluation in the control of massive hemorrhage from pelvic fractures.