Multicenter epidemiological survey and analysis of related factors in 10,808 hospitalized children with lower limb and pelvic fractures in China

Purpose: To analyze the causes, locations, associated injuries, and relevant factors of lower limb and pelvic fractures in Chinese children to provide a theoretical basis for reducing the incidence of such fractures. Methods: A retrospective analysis of children with lower limb and pelvic fractures admitted to 27 tertiary children's hospitals affiliated with China's Futang Research Center of Pediatric Development between December 1, 2015, and December 31, 2019, was conducted. Inpatient cases were analyzed in the following age groups: Infants (＜2 years), Preschool children (2-5years), School children (6-11years), and Adolescents (12-18 years). Results: This study included 10,808 pediatric patients (7,152 males, 3,656 females). The proportion of preschool children of lower limb and pelvic fractures is the highest. Of the total patients, 14, 398 had lower limb and pelvic fracture sites. The shafts of the femur, tibia, and fibula, the distal tibia, distal fibula, and the pelvis were the six most common locations. Of the 734 pelvic fractures in children and adolescents, the top three locations were the ilium, pubic bone, and the ischium. Of the total patients, 9,599 underwent surgery, while 1,209 received non-surgical treatment. The three most common causes of pediatric lower limb and pelvic fractures were falling over, traffic accidents, and falling from a height. Concomitant trauma to other systems, in 1,806 cases, had respiratory trauma as the most common; the top three conditions were pulmonary contusions, traumatic pneumonia, and pneumothorax. Concomitant nervous system trauma had scalp hematoma, intracerebral hemorrhage, and subarachnoid hemorrhage as the top three conditions. Concomitant digestive trauma had traumatic liver, splenic, and pancreatic injuries as the top three conditions. Concomitant urinary trauma had traumatic renal, urethral, and perineal injuries as the top three conditions. Concomitant circulatory trauma was in 36 cases. Conclusion: The epidemiological characteristics of lower-limb and pelvic fractures in children provide valuable information. Implementing appropriate and effective preventive measures is crucial for preventing the occurrence of lower limb and pelvic fractures in children. The treatment and management of pelvic fractures and the associated multi-system injuries resulting from high-energy trauma in children require interdisciplinary teamwork to minimize the risk of mortality in the affected children.