{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:55:28Z","timestamp":1790934928681,"version":"4.1.0"},"reference-count":78,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Introduction. Pediatric polytrauma (PPT) and major trauma in pediatric patients (PMT) present unique challenges compared to adult trauma care due to distinct anatomical and physiological differences. PPT\/PMT remains the leading cause of death in children, responsible for over 50% of pediatric deaths and 15% of pediatric hospital admissions due to its long-term effects. This single-institution study focuses on the initial management of PPT\/PMT from an orthopedics and traumatology point of view. Material and Methods. In the present study, data of PPT\/PMT managed in one single institution, an academic level I pediatric trauma center, in patients &lt;18 years of age, were analyzed over different periods. Over a 10-year period, diaphyseal femur fractures were analyzed as indicators of damage control (DCO) versus definitive treatment. Over a 4-year period (2021\u20132024), the associated lesions of PPT (head injuries, thoracic and abdominal lesions, spine lesions, major blood vessel lesions, and major musculoskeletal injury) were analyzed. Over a 1-year period (2019), the overall in-hospital mortality and admission rates in the pediatric intensive care unit were analyzed. Results. In the 10-year period, among 298 diaphyseal femur fractures, 46\/298 (15%) were classified as PPT in which DCO was performed according to age as follows: in the age-group 15\u201317 years 23\/23 (100%) with temporary external fixation (ExFix); in the age group 12\u201314 years, 9\/14 (64%) with ExFix and 5\/14 (26%) and elastic stable intramedullary nails (ESINs); in the age group 5\u201311 years, 1\/5 (20%) with ExFix and 4 with ESIN; in the age group 0\u20134 years, 2\/4 (50%) with ESIN and 2\/4 (50%) with a cast. In the 4-year period, PPT\/PMTs were associated with 60% head injury, 25% thoracic lesion(s), 18% abdominal lesion(s), 16% spine injury, 5% lesion of a major blood vessel, and 30% major musculoskeletal injuries. In 2019, there were 193 patients admitted to the emergency room as PPT\/PMT: 115 were \u226412 years old and 78 were &gt;12 years old. On admission, 46% were admitted to the pediatric intensive care unit, and 65% were admitted to the department of traumatology as inpatients. The in-hospital mortality rate was 7%. Discussion and Conclusions. In our institution, pediatric trauma is assessed using the Pediatric Trauma Score (PTS), and the workup follows the ATLS guidelines with a dedicated trauma team. The role of the orthopedic surgeon during the primary evaluation of PPT\/PMT is to contribute to stopping bleeding and hemorrhagic shock. In PPT\/PMT, DCO in adolescents is superimposable to adults, whilst in babies and children, DCO is still performed, but it is not a form of temporary external fixation.<\/jats:p>","DOI":"10.3390\/children12091194","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T08:06:32Z","timestamp":1757318792000},"page":"1194","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The \u201cBergamo Approach\u201d for Pediatric and Adolescent Polytrauma\u2014A One-Center Experience"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8237-6738","authenticated-orcid":false,"given":"Nicola","family":"Guindani","sequence":"first","affiliation":[{"name":"Orthopedics and Traumatology Unit, Regional Health Care and Social Agency Papa Giovanni XXIII, Regional Hub for the Pediatric Polytrauma, 24127 Bergamo, Lombardia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Cheli","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Unit, Regional Health Care and Social Agency Papa Giovanni XXIII, Regional Hub for the Pediatric Polytrauma, 24127 Bergamo, Lombardia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Ferrari","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Regional Health Care and Social Agency Papa Giovanni XXIII, Regional Hub for the Pediatric Polytrauma, 24127 Bergamo, Lombardia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4190-4976","authenticated-orcid":false,"given":"Giovanna","family":"Colombo","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Regional Health Care and Social Agency Papa Giovanni XXIII, Regional Hub for the Pediatric Polytrauma, 24127 Bergamo, Lombardia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6477-6965","authenticated-orcid":false,"given":"Ezio","family":"Bonanomi","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Regional Health Care and Social Agency Papa Giovanni XXIII, Regional Hub for the Pediatric Polytrauma, 24127 Bergamo, Lombardia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Chiodini","sequence":"additional","affiliation":[{"name":"Orthopedics and Traumatology Unit, Regional Health Care and Social Agency Papa Giovanni XXIII, Regional Hub for the Pediatric Polytrauma, 24127 Bergamo, Lombardia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8376-7420","authenticated-orcid":false,"given":"Maurizio","family":"De Pellegrin","sequence":"additional","affiliation":[{"name":"Orthopedics and Traumatology Unit, Regional Health Care and Social Agency Papa Giovanni XXIII, Regional Hub for the Pediatric Polytrauma, 24127 Bergamo, Lombardia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"ref_1","unstructured":"Stewart, R.M., Rotondo, M.F., Nathens, A.B., Neal, M., Caden-Price, C., Lynch, J., Burd, R.S., Maxson, F.R.T., Upperman, J.S., and Weinand, M.E. 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