Pelvic injuries are quite rare in children, but when they happen, they are often devastating injuries. They are typically due to high energy injuries such as from car accidents. The injuries are almost always severe, and often involve injuries to other organs inside the pelvis, namely the blood vessels. There are other pelvic injuries that can occur during sports, especially sports such as soccer and football, and these will be discussed below.
The pelvis is made up of the sacrum and coccyx (tailbone) of the spine along with the innominate bones. The innomate bones include the ilium, iscium, and pubis that then fuse together during puberty at the tri-radiate cartilage. The bony pelvis provides protective structure for many organs, muscles and neurovascular structures that travel in this area. Thus, damage to this area can result in major damage and injuries to these structures.
ACUTE PELVIC FRACTURES AND INJURIES
Pelvic ring fractures
As mentioned initially, pelvic ring fractures in children are rare. They result from high energy, such as either in motor vehicle accidents and/or getting hit by a car. Because the pelvis is deep inside and the bones are so strong, it takes an extensive amount of force to break the ring. The pelvic ring is designed to be extremely strong as it protects vital structures inside of it. This includes part of the bowel, bladder, reproductive organs, and urethra. The pelvic ring also protects large major blood vessels. Therefore, if the ring is broken, these organs and blood vessels are at risk of injury and can be potentially life threatening.
Most pelvic ring injuries in children, luckily, are not as severe as those seen in adults. In addition to severe car accidents, they can also be due to crush injuries, such as a TV or a piece of furniture falling directly on a young child. Those types of injuries are often treated by a period of immobilization, sometimes with a body cast (known as a spica cast) in the younger children in order to promote comfort during the healing stage.
In the picture above on the right is a 3D CT scan image of a real patient that was seen by one of the COA surgeons. She is a 13 year old female that was in a severe head-on motor vehicle collision. In the CT scan, there are multiple disruptions to her pelvic ring. After an extensive 6 hour surgery, her pelvic bones were all realigned, and she went on to a complete recovery.
These are typically sports related injuries when the muscle suddenly pulls on a portion of the pelvic bone during activities, typically running and jumping. For more information on these injuries, please click here.