Pelvic Fractures



Bones more elastic and malleable

- absorb much more energy


Very thick periosteum

- can be periosteal sleeve fracture




Triradiate cartilage fuses 13-16


Iliac / Ilium / ASIS apophysis

- appear as teenager

- fuse a couple of years later

- can confuse with fracture


Classification Key & Conwell 1951


1. No break in continuity of pelvic ring

A. Avulsion fractures

        1. ASIS

        2. AIIS

        3. Ischial Tuberosity

B. Fracture of pubis or ileum

C. Fractured wing of ileum

D. Fracture sacrum or coccyx


2. Single break in ring

A. Fracture of 2 ipsilateral pubic rami

B. Fracture near or subluxation of symphysis pubis

C. Fracture near or subluxation of SIJ


3. Double break in ring

A. Double vertical fractures or dislocation of pubis (straddle fracture)

B. Double vertical fractures or dislocation (Malgaigne fracture)

C. Severe multiple fractures


4. Fracture of acetabulum

A. Small fragment associated with dislocation of hip

B. Linear fracture associated with non-displaced pelvic fracture

C. Linear fracture associated with hip joint instability

D. Fracture secondary to central dislocation


Torode Classification


1.  Avulsion fracture

2.  Pelvic wing

3.  Stable pelvic fracture

4.  Unstable pelvic fracture


Associated Injuries Rang 1983




Haematuria 30%

Urological / bladder 10%

Abdominal injury 11%

Perineal or gluteal lacerations 7%


Vascular injuries much more rare than in adults




Head 61%

Chest 9%

Upper extremity fracture 17%

Lower Extremity fracture 17%


Mortality rate  8%


Death usually not a direct result of pelvic fracture

- rather is due to associated injuries i.e. head injury






Vaginal and rectal examination


Neurological and vascular examination




Avulsion Fractures


Tensor fascia lata, sartorius, RF, Psoas, Hamstrings

- rarely require treatment


Pubic fractures


Exclude genito-urinary injury


Unilateral Fractures

- stable 

- mobilise with crutches

- weight bear as tolerated

- usually 3-4 weeks


Bilateral Fractures



- if associated with posterior ring or sacral fracture

- potentially unstable

- usually doesn't need ORIF

- heals quickly with bed rest



- treat as Adult 

- ORIF where appropriate


Pubic Symphysis Diastasis



- urological injury

- posterior ring injury



- heals with periosteal sleeve

- if wide should close with external fixator

- if remains widened child walks with ER deformity


Acetabular Fractures


Triradiate fractures

- uncommon

- usually from extension of adjacent rami and iliac fracture

- usually stable



- child < 10

- early closure triradiate cartilage

- acetabular dysplasia




Tri-radiate fracture

- skeletal traction

- CT

- if severely displaced fragment ORIF with smooth pins


Physeal bar across triradiate cartilage

- follow up all displaced & non displaced

- consider bony bidge excision and fat graft


Vertical Shear Fractures



- associated visceral injuries

- blood loss is substantial and should be replaced

- is rare for child to die of blood loss from pelvis compared with adults



- 6 weeks of skeletal traction

- rarely need external fixator



- LLD usually < 2 cm

- contralateral hemi-epiphysiodesis