Surgical considerations with the operative fixation of unstable
paediatric pelvic ring injuries
Received: 27 October 2016 /Accepted: 23 March 2017 / Published online: 13 April 2017
SICOT aisbl 2017
Introduction The operative treatment of unstable pelvic inju-
ries in paediatrics is not frequently indicated. The detailed
modes of pelvic ring failure, surgical techniques, fixation
choices, and peri-operative difficulties are not well reported.
Methods From September 2010 to March 2016, 62 paediatric
patients were admitted to an academic level I trauma center
with the diagnosis of pelvic ring injury. Of them, 29 (17 males
and 12 females) had operative fixation of unstable pelvic in-
juries. Their average age was 11.7 ± 4.4 years.
Results There were six Tile’s B injuries and 23 type C injuries.
The commonest modes of pelvic ring failure were pubic rami
fractures anteriorly and ligamentous sacroiliac joint injuries
posteriorly. The iliac apophysis was avulsed in nine patients.
Supra-acetabular external fixators were frequently used for
anterior fixation while iliosacral IS screws and lateral com-
pression LC screws were commonly used posteriorly.
Difficulties were encountered with open reduction and repair
of avulsed iliac apophyses in two patients. The IS screws
pierced the soft iliac wing in three patients. In two patients
with open triradiate cartilage, the purchase of retrograde LC
screws was weak due the small sized crescent fragment.
Conclusion The iliac apophysis needs to be repaired follow-
ing reduction of the displaced hemipelvis. Anterior supra-
acetabular external fixation is a good choice in paediatrics
even with pubic symphysis diatasis as the pathology is
commonly a pubic apophysis avulsion. IS screws might be
inserted through plates to prevent piercing the soft iliac wing.
Retrograde LC screws should be avoided in young children.
Keywords Iliac apophysis avulsion
Lateral compression screws
Paediatric pelvic injuries
Paediatric pelvic fractures are rarely encountered and the
mainstay treatment was non-operative, particularly in young
children with immature bony pelvis, regardless of the stability
of the pelvic ring and the magnitude of displacement .
Truly unstable and displaced injuries which might be an indi-
cation for operative fixation are less frequently seen and the
literature describing the operative treatment of displaced pel-
vic ring injuries in paediatric patients is sparse [2–4].
It was thought that the thicker surrounding periosteum
would limit displacement and together with the active growth
centres around the bony pelvis, late remodeling of pelvic de-
formities would be expected [5, 6]. Recent evidence would
contradict those beliefs and post-traumatic pelvic deformities
might not remodel regardless of the age of the child at the time
of injury. In fact, persistent pelvic asymmetry causes long term
disabilities in the form of gait abnormalities, spinal deformi-
ties, chronic pain, and limb length discrepancy [1, 4, 7, 8].
Moreover, injury to the surrounding growth plates as the iliac
crest apophysis and pubic apophysis, which is frequently seen
with sacroiliac joint and pubic symphysis disruptions in im-
mature bony pelvis, might contribute to the development of
late deformities like iliac wing hypoplasia [9, 10].
Many studies have reported the long term functional out-
come of displaced pelvic ring injuries in paediatric patients.
Smith et al.  found that pelvic asymmetry ≥ 1.1 cm as
The original version of this article was revised: On the request of Dr.
Kenawey, the presentation of Tables 1 and 3 were correted as well of
the deletion of the duplicate reference .
* Mohamed Kenawey
Orthopaedic Department, Sohag University Faculty of Medicine,
Sohag 82524, Egypt
International Orthopaedics (SICOT) (2017) 41:1791–1801