Response to the article titled “Associated injuries and complications in pediatric pelvic fractures requiring hospitalization: A series of 315 cases”

Dear Editor and Prof. Subasi M et.al,

We would like to express my sincere gratitude for your letter in response to the article titled “Associated injuries and complications in pediatric pelvic fractures requiring hospitalization: A series of 315 cases,” which was published in the March 2024 issue of Journal of Children’s Orthopaedics. ¹ We are honored that you took the time to share your insights on this critical topic, and I truly appreciate the wealth of knowledge you have provided in your detailed correspondence.

Your letter draws attention to the complexities involved in managing pediatric pelvic fractures, emphasizing the significant association between these fractures and other severe injuries, including those to the urethra, head, and femur. Your study, conducted in 2004, focused on the long-term outcomes of conservatively treated pediatric pelvic fractures and provides compelling data on the potential complications that can arise. ² We would like to both acknowledge the contributions of your study and extend the discussion with additional perspectives on the management of pediatric pelvic fractures, especially concerning modern treatment protocols and psychosocial aspects.

First, your focus on the high incidence of urethral injuries among pediatric patients with pelvic fractures is a crucial point that warrants further discussion. The 71% incidence of urethral injuries observed in your cohort is significantly higher than what is typically reported in the literature. This highlights the need for a more robust approach to identifying and managing urethral trauma in pediatric pelvic fracture patients, particularly since such injuries may have long-lasting consequences, as reflected in your findings of urinary incontinence and erectile dysfunction. ³ In addition to the high incidence of urethral injuries, you also highlighted the psychological burden experienced by children who sustain pelvic fractures. This is an area that has often been overlooked in pediatric trauma care. The psychiatric disorders, including dysthymia, social phobia, posttraumatic stress disorder (PTSD), and major depression, reported in your study, underscore the long-term emotional and mental health challenges faced by children with severe injuries. Acknowledging the psychological impact of pediatric pelvic fractures is not only critical for patient recovery but also essential for improving the overall quality of life for these children in the long run. Although we are striving to advance this work, due to regional cultural differences and traditional conservative beliefs, it is very difficult to conduct psychiatric and psychological assessments and genitourinary functional assessments on patients in our cohort. Even though these problems objectively exist, families and patients themselves are often embarrassed or reluctant to discuss them.

Initially, we also believed that conservative treatment should be sufficient for pelvic fractures in patients with immature skeletons, leading to satisfactory prognoses. However, through our clinical work, we gradually discovered that the growth potential and pelvic remodeling capacity of children might not be adequate to compensate for the impact of malunited pelvic fractures on lower limb function. Recently, we conducted a study on a cohort of 96 patients with long-term follow-up (average follow-up time of 3.6 years, range: 2–8 years) and found that surgical treatment for Tile B and C type pelvic fractures yielded relatively satisfactory results in both WeeFIM scores (71 cases of complete independence, 13 cases of conditional independence, 6 cases of conditional dependence (supervision and setup), 5 cases of conditional dependence (minimal physical assistance)) and Cole pelvic fracture functional ratings (63 cases of excellent, 17 cases of good, 10 cases of fair, 6 cases of poor).

As you rightly pointed out, the treatment and outcomes of pediatric pelvic fractures differ significantly from those in adults. It is not enough to merely achieve fracture union. Restoring the restoration of the child’s overall well-being. As a pediatric trauma center, we should consider adopting a more holistic, patient-centered approach that not only addresses the immediate orthopedic needs but also integrates physical therapy, psychological counseling, and social support services into the treatment plan. The role of multidisciplinary teams, including pediatric orthopedic surgeons, urologists, psychiatrists, rehabilitation therapists, and social workers, cannot be overstated. It is only through such collaborative efforts that we can hope to achieve the best possible outcomes for these children. This is also what we currently lack and are constantly striving to improve.

In conclusion, I believe that your study and the letter you have written serve as an important reminder of the complexities involved in treating pediatric pelvic fractures. The high incidence of associated injuries, the long-term psychological impact, and the importance of a multidisciplinary approach to treatment are all critical factors that must be considered when managing these cases. We agree wholeheartedly with your conclusions and would like to reiterate the importance of continued research and collaboration in this field. If possible, we would be very willing to communicate and collaborate with your team, such as comparing cohorts of patients undergoing surgical and conservative treatment.

Once again, I would like to thank you for your insightful comments and for sharing your valuable perspectives. Your contributions to this field are truly appreciated, and I look forward to further discussions and developments in pediatric trauma treatment and care.

Supplemental Material

sj-pdf-1-cho-10.1177_18632521251330454 – Supplemental material for Response to the article titled “Associated injuries and complications in pediatric pelvic fractures requiring hospitalization: A series of 315 cases”

Supplemental material, sj-pdf-1-cho-10.1177_18632521251330454 for Response to the article titled “Associated injuries and complications in pediatric pelvic fractures requiring hospitalization: A series of 315 cases” by Baojian Song, Hanwen Zhang and Xuejun Zhang in Journal of Children’s Orthopaedics