Epidemiology and clinical outcomes of pediatric pelvic fractures: A retrospective study from two Level-1 trauma centers

Background: Pediatric pelvic fractures are uncommon, accounting for 0.5–7% of blunt pediatric trauma, but are frequently associated with high-energy mechanisms, severe concomitant injuries, and substantial morbidity. Clinical management varies significantly based on type, severity and associated injuries. Unique characteristics of the pediatric pelvis play a crucial role in management and long-term outcomes (growth disturbances, deformities, pain, mobility limitations), significantly affecting function and well-being. This study aims to describe the epidemiology and factors associated with morbidity and mortality. It also characterizes changes in injury patterns over time.

Methods: We performed a retrospective study of children with pelvic fractures treated at two Level-1 trauma centers between 2006 and 2024. Demographic characteristics, injury mechanisms, fracture classifications, associated injuries, treatment, complications, morbidity and mortality were collected. Fractures were independently classified (Torode + Young and Burgess classifications) by two senior orthopaedic surgeons.

Results: A total of 352 children were included (250 males; 71%; mean age 10.4 ± 4.6 years). Pedestrian motor vehicle collisions were the most common injury mechanism (146 cases, 41%), followed by falls from height (79, 22%). Most fractures were Torode grade III–IV (273 patients, 78%), and 204 children (58%) sustained associated injuries. Thirty-seven patients (11%) underwent pelvic surgery. Multivariable analysis demonstrated that mortality was independently predicted by severe pelvic injury according to the Young and Burgess classification (Odds Ratio (OR)=14.1, 95% CI 3.1–63.5) and associated head or neck injuries (OR=14.2, 95% CI 3.3–60.6). Over the two decades, annual case volume increased by ~34%, accompanied by a higher proportion of severe pelvic fractures, although treatment strategies remained largely unchanged.

Conclusions: The increasing incidence of severe injuries over time underscores the importance of early risk stratification, standardized management pathways, and prospective multicenter studies to increase our understanding of the long-term implications of these fractures.