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14 Jul 2025
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Pediatric Pelvic Ring Disruption with Ipsilateral Femur Fracture and Soft Tissue Injury.

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Clinical Details

Clinical and radiological findings:  A 24-month-old patient was involved in a low-speed run-over accident, resulting in a complete right-sided hemipelvis dissociation with intraoital tear, a subtrochanteric femur fracture, and a full-thickness skin injury to the ipsilateral leg and foot. The Risser sign and triradiate cartilage were uninjured. The patient did not sustain any head, chest, or abdominal injuries.

Preoperative Plan

Planning remarks:  The preoperative plan included initial debridement and irrigation of the open pelvic injury, followed by external fixation for reduction and stabilization. Subsequent surgical intervention involved suture fixation of the symphysis pubis and percutaneous screw fixation of the sacroiliac joint. For the femur fracture, flexible intramedullary nailing was planned to accommodate necessary wound care.

Surgical Discussion

Patient positioning:  Supine positioning was utilized for surgical access to both the pelvis and femur.

Anatomical surgical approach:  A midline lower abdominal incision was used for access to the pelvic ring, allowing for debridement and symphyseal suture fixation. Percutaneous approach was employed for sacroiliac joint screw placement. The femur was accessed via a lateral approach for insertion of flexible intramedullary nails.

Operative remarks: 

The surgeon noted the rarity of such pediatric pelvic injuries and consulted with experts in pediatric pelvic trauma. The decision to use external fixation initially was due to the open nature of the injury, with subsequent internal fixation for definitive stabilization. Flexible nails were chosen for the femur to allow for ongoing wound care without the constraints of a hip spica cast.

Postoperative protocol:   Postoperative rehabilitation included maintaining the external fixator for 4-6 weeks, with removal of the sacroiliac screw at 3 months. Daily wound care was planned for the soft tissue injury, with involvement from plastic surgery colleagues for coverage of the distal wound.

Follow up:   Not specified.

Orthopaedic implants used:   External fixator, 5.5mm cannulated screw with washers, flexible intramedullary nails.

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