Functional Outcomes of Pediatrics and Adolescent Pelvic Fractures: A Systematic Review
Vincent Buckman, Patrick Sun, Jeffrey Blibo, Nirav PandyaBackground:
Pelvic fractures are rare injuries, representing 1% to 2% of fractures among pediatric and adolescent populations. Although uncommon, these injuries differ significantly from adult fractures due to skeletal immaturity and increased potential for bone remodeling. Currently, there is limited understanding of the long-term outcomes of pediatric pelvic fractures. This study aims to review the functional outcomes of pediatric and adolescent pelvic fractures.
Methods:
Following PRISMA guidelines, a systematic review was performed using PubMed, Embase, Scopus, and Google Scholar databases. Three independent authors screened all eligible studies, extracted the data, and assessed risk of bias. The types of studies included in the analysis were retrospective and prospective human cohort studies, as well as case series. The primary outcome of interest was functional outcomes by fracture stability and management. Secondary outcomes included radiologic and structural complications. Weighted pooled analyses were conducted where feasible.
Results:
Fourteen studies (n=731) were included in the review. Across reporting studies, more than 90% of patients regained independent ambulation and returned to activities of daily living regardless of management strategy and fracture stability. Pelvic asymmetry was the most frequently reported structural complication, occurring in 22 of 253 patients (8.7%). Other structural complications included limb length discrepancy (23/333; 6.9%), acetabular dysplasia (3/178; 1.7%), and nonunion (6/549; 1.1%).
Conclusion:
Pediatric and adolescent pelvic fractures demonstrate favorable functional outcomes when management strategies are appropriately aligned with fracture stability. However, operative fixation could be considered in selective patients with stable fractures who are hemodynamically stable and at low surgical risk to modify the risks of rare complications such as pelvic asymmetry, limb length discrepancy, and nonunion.
Level of Evidence:
Level III—systematic review of level I to IV studies.