Case Report: Pelvic Fractures
Pediatric Trauma Society Education Committee Report
K is a 14 yo female with a history of ADHD, anxiety, and OCD involved in an MVC.
K arrived in the Level 2 pediatric trauma center via helicopter transport after intentionally running into traffic and being struck by a truck. The patient argued with parent and ran out in front of a moving semi-truck. Upon EMS arrival, she had a GCS of 9 and was sedated and orally intubated. She had bilateral open femur fractures and deformity of both lower extremities and facial swelling and deformity. EMS was on scene 11 minutes before helicopter arrival for transport.
On arrival to the emergency department, the patient had extensive bruising to the abdomen, bleeding at the perineum and a head laceration. The patient received one unit of PRBC prior to arrival and the massive blood transfusion protocol was initiated on arrival and ROTEM ordered. The initial blood pressures were in the 90s over 60s. After the third unit of blood, the BP was 106/64, and platelets were started.
A pelvic binder was applied and orthopedic surgery was consulted to evaluate. The head CT was negative. Injuries identified in the emergency department include a laceration extending from the left thigh to the rectum including the labia, bilateral superior and inferior pubic ramus fractures, extensive soft tissue injuries with soft tissue gas right upper thigh/hip laterally plus distal thigh with a few scattered foreign bodies and an apparent triangular foreign body lateral to the greater trochanter, fractures at the bases of the third and fourth metatarsals, an extensive scalp injury, facial fractures including left orbital floor fracture displacement, nasal fractures, multiple open pelvic and, severe soft tissue injury right lateral hip coming around to the groin with extensive skin loss. After stabilization of vital signs, initiation of a Precedex infusion for sedation, and arrival of the interventional radiology team, the patient was transported to surgery. Total time in the emergency department was approximately 5 hours.
Surgical procedures include central line placement, IR embolization, external hip fixator placement; debridement & wound vac to right thigh, vaginal & anal laceration repair, & laceration repair on scalp. Throughout the 72 hospital stay, the patient required repeat I&D of vaginal and anal wounds and antibiotics for would infection. The patient continues to require physical therapy and assistive devices for mobilization. The patient also attends partial hospitalization counseling for PTSD.
Orthopedic injuries in pediatrics
Pelvic fractures in pediatric patients result from significant force and requires evaluation for other significant injuries and hemodynamic stabilization.