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外文期刊>Journal of children's orthopaedics
>Analysis of pelvic fracture pattern and overall orthopaedic injury burden in children sustaining pelvic fractures based on skeletal maturity
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Analysis of pelvic fracture pattern and overall orthopaedic injury burden in children sustaining pelvic fractures based on skeletal maturity
Paediatric pelvic fractures are rare injuries with an incidence of 1 per 100 000 per year and represent 1% to 2% of fractures in children.1-6 Morbidity and mortality of these injuries are higher when compared with other fractures.7,8 Disruption of the pelvic ring results from high-energy mechanisms that warrant an extensive workup for associated injuries. Mortality in paediatric patients sustaining pelvic fractures is lower than their adult counterparts.9 Fatal haemorrhage seen in adult patients with pelvic fractures is rare in the paediatric population. Instead, paediatric bleeding related to a pelvic fracture is typically due to solid-organ injuries,10 making identification and treatment of these life-threatening injuries crucial.The triradiate cartilage is the most important growth plate in the acetabular floor and closes between the ages of 12 and 18 years. Radiographic interpretation of the patency of the triradiate cartilage is an accurate method of determining skeletal maturity11 and its patency is an important distinction when assessing pelvic and extremity injuries in paediatric patients.12 The unfused innominate bone is considerably more flexible due to a higher cartilage content and greater elasticity both at the pubic symphysis and sacroiliac joints.13,14 The production of fractures requires great force, which presumably leads to a greater burden of concomitant injuries.15The classic classification system for paediatric pelvic fractures was developed by Torode and Zeig in 1985. Using radiographs alone, the classification divides injuries into four groups: (I) avulsion fractures; (II) iliac wing fractures; (III) simple ring fractures; and (IV) ring disruption fractures.16 Shore et al modified the Torode classification by using CT scans in addition to radiographs. They further subdivided type III injuries into A and B. The III-A injury is a stable anterior ring fracture, while the III-B injury represents a stable injury that also involves the posterior ring. Type IV fractures include unstable injuries such as ring disruptions, hip dislocations and associated pelvic fractures combined with fractures of the pelvis and the acetabulum.17 The modified classification system has been found to be predictive for significant morbidity and death in multi-trauma patients.17We performed a retrospective study to review pelvic fracture patterns and concomitant orthopaedic injuries in children who have an open triradiate cartilage (TRO) compared with children with a closed triradiate cartilage (TRC). We hypothesise that based on the patency of the triradiate cartilage, these injuries will differ, ultimately leading to differences in management.
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