Clinical and surgical outcomes of pediatric pelvic fractures: experience from a mass-casualty and routine trauma cohort.

Abstract

Pediatric pelvic fractures are rare but potentially life-threatening injuries associated with high-energy trauma and complex anatomical considerations. Surgical management is often required, necessitating multidisciplinary care. This study aimed to evaluate the clinical outcomes of surgically treated pediatric pelvic fractures, with special emphasis on earthquake-related injuries. This retrospective, single-center study included 36 pediatric patients (aged 0-17) who underwent surgical treatment for pelvic fractures between January 2021 and October 2024. Demographics, injury mechanisms, fracture types (Torode and Zieg classification), surgical procedures, and short-term outcomes were analyzed. A subgroup comparison was performed between earthquake-related and non-earthquake trauma cases. Earthquake-related trauma was the most frequent mechanism (36.1%), followed by motor vehicle accidents (30.6%) and falls from height (25%). Type IVB fractures were the most common (55.6%). Earthquake-related cases showed longer time to surgery (8.5 vs. 2.3 days, p < 0.001) and higher postoperative CRP (116.7 vs. 33.2 mg/L, p < 0.001). Despite greater injury severity, the majority of patients achieved functional recovery: 63.9% regained full mobility, while 33.3% walked normally with limited running. The overall complication rate was low (16.6%), and no life-threatening events occurred. Hospitalization costs were higher in earthquake cases, driven by Intensive Care Unit (ICU) stay and surgical delay. Surgical stabilization of pediatric pelvic fractures achieved favorable short-term outcomes with low complication rates, even in earthquake-related mass-casualty settings. Earthquake cases presented with more severe patterns, longer time to surgery, and greater inflammatory and resource burdens, underscoring the need for rapid triage, coordinated multidisciplinary care, and early mobilization despite operational constraints. These findings argue for disaster-ready pediatric trauma systems and merit validation in prospective multicenter cohorts with long-term functional and economic endpoints.