Copyright 983 by The Journal of Bone and Joint Surger. Incorporated 1290 THE JOURNAL OF BONE AND JOINT SURGERY Multiple Injury in Children*t

ABSTRACT: We studied thirty-four consecutive sur-viving children who had severe injuries, including a ma-jor fracture of at least one extremity or of the pelvic girdle, and at least one other major injury. The severity of the injuries was classified according to the Modified Injury Severity Scale, and that scale proved to be pre-dictive for morbidity and residual impairment. The study showed that in one-third of the patients there was substantial residual impairment that was attributable to their musculoskeletal and neural injuries. Most of the musculoskeletal impairment was at-tributable to the nature of the skeletal injury rather than to the treatment. In children, severe trauma ranks second only to acute infection as the major cause of morbidity. Accidents cause one-half of all deaths in children who are between one and fifteen years old4. Children. however, are able to survive extremely severe injuries. and often respond better to treat-ment than do adults79. The morbidity in children is usu-ally related to injury to the central nervous system. but in the present study we wished to determine what role skeletal injuries play in morbidity and residual impairment. There-fore we reviewed our experience with severely injured chil-dren and adolescents. all of whom had musculoskeletal injuries. Materials and Methods The records of all children and adolescents who had multiple associated musculoskeletal injuries treated at th