Pelvic Fracture In Children

WHAT YOU SHOULD KNOW:

  • A pelvic fracture occurs when one or more of the pelvic (hip) bones are broken. The pelvic area, or pelvis, is a ring-like structure of different bones in the lower portion of the trunk. Three separate bones, the ilium, ischium, and pubis, make up the pelvis. These bones fuse together as your child gets older. Pelvic fractures are usually caused by direct trauma, such as car accidents or falling from high places. Sports that need quick running starts and quick stopping, like soccer or football, may also break pelvic bones.
    Bones of the Pelvis


  • Signs and symptoms of a pelvic fracture include pain, swelling, bleeding, or deformity in the hip area. He may also have trouble moving, sitting, or walking. An x-ray, magnetic resonance imaging (MRI), or computerized tomography (CT) scan may be used for diagnosis. Treatment may include medicines for the relief of symptoms or surgery if the fracture is unstable. The younger your child is, the faster the fracture will heal without further problems. With proper treatment, such as medicine and rehabilitation, your child has a greater chance of having a full recovery.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

RISKS:

A pelvic fracture can be a very serious injury and cause other problems. The pelvic bones may not fit back together on their own and may need surgery. The muscles around the fracture may be affected and may become weak. Your child may have problems with his leg or foot, if a nerve is cut or blocked by the fracture. A pelvic fracture may cause bleeding, deformity, infection, or damage to the abdomen (belly), kidneys, or urinary bladder. If not treated as soon as possible, spinal cord damage, paralysis, and even death may occur.

Sometimes, treatment for a pelvic fracture may cause unwanted side effects. Medicines may cause your child to have nausea (upset stomach), vomiting (throwing up), or stomach ulcers (sores). He may bleed or get an infection if he has surgery. Even with treatment, your child may have life-long problems. He may have long-term back or pelvic pain or his legs may be of an unequal length. He may also have impotence (unable to have an erection) when he grows up. Ask your child's caregiver if you have concerns about his fracture, medicines, or care.

WHILE YOU ARE HERE:

Informed consent

is a legal document that explains the tests, treatments, or procedures that your child may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your child's medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done to your child. Make sure all of your questions are answered.

Activity:

Your child may need to rest in bed for a while so his pelvic fracture can heal. When his pain decreases, your child may need to start moving or walking to make his bones heal faster. This will also prevent your child from having other serious problems, such as skin sores or infections.

Blood tests:

Your child may need blood tests to give caregivers information about how his body is working. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV.

Emotional support:

Stay with your child for comfort and support as often as possible while he is in the hospital. Ask another family member or someone close to the family to stay with your child when you cannot be there. Bring items from home that will comfort your child, such as a favorite blanket or toy.

A Foley catheter

is a tube put into your child's bladder to drain urine into a bag. Keep the bag below his waist. This will prevent urine from flowing back into his bladder and causing an infection or other problems. Also, keep the tube free of kinks so the urine will drain properly. Do not pull on the catheter. This can cause pain and bleeding, and may cause the catheter to come out. Caregivers will remove the catheter as soon as possible to help prevent infection.

An IV

is a small tube placed in your child's vein that is used to give him medicine or liquids.

Medicines:

Your child may need one or more of the following:

  • Antibiotics: This medicine is given to help prevent or treat an infection caused by bacteria.

  • Blood thinners: These medicines prevent blood clots that often form after a pelvic fracture. Blood thinners may be given before, during, and after surgery. They may first be given in your child's IV or as a shot in his abdomen (belly). Later, the medicines may be taken by mouth or continue as a shot. Blood thinners may make it easier for your child to bleed or bruise. Ask your child's caregiver on how to prevent bruising or bleeding.

  • Pain medicine: Your child may need medicine to take away or decrease pain. Know how often your child should get the medicine and how much. Watch for signs of pain in your child. Tell caregivers if his pain continues or gets worse. To prevent falls, stay with your child to help him get out of bed.

  • Tetanus shot: This is medicine to keep your child from getting tetanus if the fracture also has an open wound. It is given as a shot. Your child should have a tetanus shot if he has not had one in the past 5 to 10 years. Your child's arm can get red, swollen, and sore after getting this shot.

Pneumatic boots:

These are plastic boots or leggings put on your child's feet or legs over pressure stockings or ace wraps. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the boot or legging. This helps push the blood back up to the heart to keep blood clots from forming. Ask your child's caregiver for more information about pneumatic boots.

Tests:

Your child may have one or more of the following:

  • Bone x-rays: Your child may need to have x-rays of his hips, thighs, abdomen, or ribs taken to check for broken bones.

  • Computerized tomography scan: This is also called a CT or CAT scan. A special x-ray machine uses a computer to take pictures of your child's hips. It may look at your child's bones, muscles, blood vessels, and organs in the hip and abdominal area. Your child may be given dye by mouth or in an IV before the pictures are taken. The dye may help your child's caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your child's caregiver if he is allergic to shellfish, or has other allergies or medical conditions.

  • Magnetic resonance imaging scan: This test is also called an MRI. An MRI uses magnetic waves to take pictures of your child's hips. During an MRI, pictures are taken of his bones, abdominal or pelvic organs, or blood vessels. He will need to lie still during an MRI. Never enter the MRI room with any metal objects. This may cause serious injury.

Treatment options:

Your child may need one or more of the following:

  • Aiding devices:

    • Fixators: A piece of metal equipment, called an external fixation device, may be put on your child's hips. Screws or special clamps are used to hold the broken bones together while they heal.

    • Stabilizers: Caregivers may lay your child flat on a special backboard with his body strapped down. They may also use slings, casts, pneumatic anti-shock garments, pads, pelvic girdles, belts, or collapsible bean bags. These will prevent his broken bones from moving.

  • Blood transfusion: During a blood transfusion, your child will get whole blood, or parts of blood through an IV. You may be worried that your child will get AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus.

  • Irrigation and debridement: This is done when there is an open wound on the pelvis. This will clean and remove objects, dirt, or dead tissues from the fracture area.

  • Supportive therapy: Ice packs may be put on your child's pelvis to decrease swelling, pain, and redness. Your child may have to use crutches to help him walk. Crutches will also help take some weight off the injured pelvis while it heals.

  • Surgery: Your child may need surgery to return the bones to their normal position if the fracture is unstable. Pins, plates, and screws may be used to hold the bone together. Injury to the kidneys, genitals, abdominal organs, blood vessels, or nerves may also be treated with surgery.

Rehabilitation:

Rehabilitation programs may help your child get back or maintain activities that are important to his daily living. Therapists teach him special skills to recover faster and have a better life.

  • Physical therapy: Your child's caregiver may want him to go to physical therapy or PT. A physical therapist will help your child with special exercises. These exercises will help make his bones and muscles stronger.

  • Occupational therapy: Occupational therapy, or OT, uses work, self-care, and play activities to help your child in his daily life. There are many ways occupational therapy may help your child become better able to take care of himself. It may teach him special skills for bathing, dressing, and eating. An occupational therapist may help your child use tools to get things done at home or school. The therapist may suggest ways to keep your home or your child's school safe. You, your child, and his therapist will plan a therapy program that is right for him.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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