Epidemiology and injury patterns of high-energy pediatric pelvic and acetabular fractures: A retrospective study with comparative outcomes.

BACKGROUND: This study aimed to evaluate the epidemiological characteristics, injury mechanisms, fracture patterns, associated injuries, and early hemoglobin (Hb) changes and physiological response in pediatric patients with pelvic fractures. In addition, clinical and injury-related variables were compared according to skeletal maturity status and treatment modality. METHODS: This retrospective single-center study included 52 consecutive patients younger than 18 years who were treated for pelvic fractures between September 2022 and March 2025. Skeletal maturity was determined based on triradiate cartilage status. Fractures were classified using Torode-Zieg, Young-Burgess, and Letournel-Judet systems. Early physiological response was assessed using serial Hb measurements at admission, 24 h, and 48 h. Comparative analyses were performed according to skeletal maturity and treatment modality. RESULTS: The median age was 14 years, and 55.8% of patients were female. Pelvic ring injuries were observed in 76.9% of patients, and associated injuries were present in 67.3%. Non-operative treatment was performed in 65.4% of patients. Hb levels decreased from 12.3±1.8 g/dL at admission to 11.1±2.0 g/dL at 24 h and 10.5 g/dL at 48 h. No significant differences in Hb decline were observed according to skeletal maturity (p>0.05). Patients who underwent operative treatment had significantly lower Hb levels at 24 and 48 h (p=0.006 and p=0.005, respectively); however, the magnitude of Hb decrease did not differ significantly between treatment groups (p>0.05). CONCLUSION: Pediatric pelvic fractures are uncommon injuries typically associated with high-energy trauma and multiple concomitant injuries. Early Hb decline was modest and did not differ according to skeletal maturity. Lower Hb levels in surgically treated patients may reflect overall injury severity rather than pelvic fracture-related hemorrhage. Careful evaluation of associated injuries and close monitoring of Hb levels are essential in pediatric pelvic trauma.