The application of lateral-rectus approach on toddlers\u2019 unstable pelvic fractures

Yuancheng Liu,Cheng Yang,Fuming Huang,Yuhui Chen,Shicai Fan,Xiangyuan Wen,Xiaorui Zhan

doi:10.1186/s12891-020-3172-1

Yuancheng Liu, Cheng Yang + Show 5 more

Open Access

https://doi.org/10.1186/s12891-020-3172-1

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Abstract

BackgroundPelvic fractures are rare in toddlers but are often associated with other injuries that make treatment difficult. Conservative treatment has been used with moderate success, but it is unclear if surgical correction could confer additional benefits and improve patient outcomes. The purpose of this study was to report authors’ experience using the lateral-rectus approach (LRA) for surgical correction of unstable pelvic fractures in two toddlers.MethodsWe retrospectively analyzed the cases of two toddlers with unstable pelvic fractures who underwent surgery through the LRA between April 2016 and October 2018. Patients’ characteristics, fracture type, mechanism of injury, Injury Severity Score (ISS), operative time, intra-operative blood loss, and post-operative complications were assessed. Pelvic asymmetry, degree of deformity, Cole scoring criteria and modified Barthel Index (MBI) were used to evaluate radiographic and functional outcomes.ResultsSuccessful surgical treatment was performed using the LRA, external fixation, and sacroiliac screw fixation. Surgery duration was 180 min on average, with an average intra-operative bleeding of 250 ml. There were no iatrogenic nerve injuries or infections. Pelvic asymmetry a week after surgery was 0.5 cm on average and dropped to 0.3 cm on average at the end of the follow-up period. The deformity index of the pelvis dropped from an average of 0.035 a week after surgery to 0.02 at the end of the follow-up period. The mean MBI was 100 in the last follow-up, and Cole scoring criteria categorized both patients as being in excellent condition. All patients achieved radiological bone union without discrepancy in length of the lower limbs. Neither patient had loss of reduction nor evidence of low back pain during the mean follow-up period of 22 months.ConclusionsPelvic fracture in toddlers is rare, and surgical treatment requires careful consideration. The lateral-rectus approach was proven as a viable alternative for managing unstable pelvic fractures in toddlers, with minimal blood loss and risk of nerve injury. Furthermore, anterior external fixation and posterior sacroiliac screw fixation would be adequate for this population, with excellent final outcome.

Highlights

Pelvic fractures are rare in toddlers but are often associated with other injuries that make treatment difficult
This study aimed to report the authors’ experience of using the lateral-rectus approach (LRA) for surgical correction of unstable pelvic fractures in two toddlers
After receiving approval from the Ethics Committee, we evaluated the cases of two female toddlers who underwent surgical repair for unstable pelvic fractures by the same trauma orthopedic specialist between April 2016 and October 2018

Summary

Introduction

Pelvic fractures are rare in toddlers but are often associated with other injuries that make treatment difficult. The purpose of this study was to report authors’ experience using the lateral-rectus approach (LRA) for surgical correction of unstable pelvic fractures in two toddlers. Up to 10% of pediatric pelvic fractures are unstable [3] These fractures usually occur as a result of pedestrians being hit by cars and are often accompanied by injuries to the controversy still exists regarding the treatment of pelvic fractures in children. Recent studies have shown that the remodeling ability of children after pelvic fracture is suboptimal [10, 11]. It is becoming increasingly accepted that surgically repairing unstable or displaced pelvic fractures, regardless of patient age or skeletal maturity, is beneficial [12]

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