Treatment of Pediatric and Adolescent Pelvic Ring Injuries With Percutaneous Screw Placement.

BACKGROUND: Pediatric and adolescent pelvic ring injuries are frequently treated without surgery. In patients with unstable injuries to the pelvic ring, surgical stabilization aids in resuscitation, provides pain relief, and allows for mobilization. Percutaneous pelvic screw fixation is commonly performed in adult patients for unstable pelvic ring injuries, but a paucity of literature exists regarding their use in pediatric patients. The purpose of this study is to review the use, outcome, and management of percutaneous posterior pelvic screws in pediatric patients with unstable pelvic ring injuries.

METHODS: A retrospective review of a prospectively collected orthopaedic trauma database was performed over a 7-year period at a regional level-1 trauma center. All patients between the ages of 7 and 17 who sustained an injury to the pelvic ring and were treated with percutaneous fixation of the posterior pelvic ring were identified. We evaluated the frequency of this technique in the described patient population, incidence of nerve injury, infection, loss of fixation, and need for hardware removal.

RESULTS: A total of 238 pediatric patients who sustained a pelvic ring injury were initially identified; following application of study criteria, 67 (28.1%) patients were included in the study. Additional anterior ring fixation was performed in 33 (49.2%) patients. There were no iatrogenic nerve injuries, no infections, and surgical blood loss was <50 mL in all cases. Clinical and radiographic follow-up averaged 33 weeks. No loss of reduction was observed. Eight patients (13%) reported persistent low back pain at last follow-up. Elective hardware removal was performed in 3 patients.

CONCLUSIONS: The majority of pediatric pelvic ring injuries can be treated without surgery. In the setting of instability, percutaneous pelvic screw fixation can be performed safely. A computed tomography scan is used to evaluate the available osseous pathways for screws and intraoperative fluoroscopy is used to safely perform this technique. Screw removal should be discussed in select patients.

LEVEL OF EVIDENCE: Level IV.