Treatment of unstable pelvic fractures in children with an external fixator: Retrospective study of 56 patients

Purpose: We retrospectively analyzed the data of patients who underwent external fixation treatment for unstable pelvic fractures and evaluated the clinical effects of this treatment and factors influencing pelvic function recovery.Methods: The data of patients with unstable pelvic fractures treated with an external fixator between January 2006 and December 2018 were retrospectively analyzed. The analyzed parameters included demographic data, fracture healing, pelvic asymmetry, deformity index, and complications. Fractures were categorized using the Tiles classification. Pelvic function was evaluated using the Cole score. Pelvic risk factors were identified using univariate and multivariate logistic regression analyses.Results: Fifty-six patients (29 and 27 with type B and C fractures, respectively) were included. All fractures were healed at the time of the final follow-up. Nine and three patients had pin tract infections and loosened external fixators postoperatively, respectively. Pelvic asymmetry was reduced from 1.34 +/- 0.15 cm to 0.70 +/- 0.19 cm (p < 0.01), and the deformity index decreased from 0.13 +/- 0.03 to 0.07 +/- 0.02 (p < 0.01). The Cole score was excellent and good in 41 and 15 patients, respectively. Risk factors for pelvic function recovery included injury severity score > 25.5, age > 11.3 years, and lower-extremity fractures.Conclusions: External fixation is an effective method for treating unstable pelvic fractures in children, with the advantages of a simple operation, short surgical time, no interference with treatments for associated injuries, and avoidance of re-trauma caused by open reduction. An ISS > 25.5, patient age > 11.3 years, and associated lower-extremity fractures are predictors of pelvic function recovery.Level of evidence: Level IV.