Breaking Bad News · Advanced · Ethics

Pelvic Fracture in Child

Practise this PLAB 2 breaking bad news station on Paediatric Pelvic Fracture. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are the senior house officer (SHO) in paediatric orthopaedics in an acute hospital. Emma, a 7-year-old girl, has been brought to A&E following a road traffic accident. Imaging shows a pelvic fracture. You need to inform her mother, Mrs Marlene Rose, about the injury, discuss management, and address her concerns about recovery and long-term outcomes.

Background notes: PMH: Otherwise healthy child, up-to-date vaccinations, normal development

What this station tests

  • Leading with stability reassurance: 'she is stable and comfortable' before describing the injury
  • Children's bones heal faster than adults: important reassurance for paediatric fractures
  • Conservative management for stable paediatric pelvic fractures: bed rest, analgesia, physiotherapy
  • Recovery timeline: specific milestones (school return, cycling return) that matter to the family
  • Addressing parental guilt: normalising childhood accidents without being dismissive

How to use your 8 minutes

  • 0-1 min — Setting: Introduce yourself. Ensure privacy. Ask what they already know (SPIKES: Perception).
  • 1-2 min — Warning Shot: Give a warning shot. 'I'm afraid I have some difficult news.' Pause and allow reaction.
  • 2-4 min — Deliver Information: Give information in small chunks. Use clear, simple language. Avoid euphemisms. Pause after key information.
  • 4-6 min — Respond to Emotion: Acknowledge and validate emotions. Allow silence. Empathic statements. Address immediate concerns.
  • 6-8 min — Plan and Support: Discuss next steps when patient is ready. Offer support resources. Arrange follow-up. Written information.

Consultation approach

The opening

Explaining a significant fracture in a child to a parent requires clear communication about the injury, treatment plan, and recovery, while managing the mother's distress. Emma (7) has a pelvic fracture from a cycling accident. Her mother Marlene is anxious. Open with: 'Mrs Rose, Emma is stable and comfortable. I want to explain what we have found and what happens next.'

Core approach

Lead with reassurance about stability. 'Emma is not in immediate danger. She has a fracture of her pelvis from the accident. I know that sounds frightening, but pelvic fractures in children generally heal very well because children's bones repair much faster than adults.' Explain the specific fracture type and whether it is stable (most paediatric pelvic fractures are).

Treatment plan: most stable paediatric pelvic fractures are managed conservatively (bed rest, pain management, physiotherapy). Surgery is only needed for unstable fractures with displacement. She will be in hospital for monitoring and pain control. Analgesia: multimodal (paracetamol, ibuprofen, opioid for breakthrough). She will need bed rest initially, then gradual mobilisation with physiotherapy.

Address the mother's specific concerns: will Emma walk again (yes), will it affect her growth (very unlikely), when can she return to school (typically 4 to 6 weeks), when can she cycle again (3 to 6 months).

Closing and safety netting

Recovery timeline: bed rest for 1 to 2 weeks, then progressive weight-bearing with physio. Most children return to full activity by 3 months. Follow-up imaging to confirm healing. She will need outpatient physiotherapy.

Address the mother's guilt (she was supervising when Emma fell from the bicycle): 'Accidents happen. Children fall off bikes. You did exactly the right thing bringing her in.' Safety net: 'If Emma develops any difficulty passing urine, numbness in her legs, or increasing pain despite medication, tell the nursing team immediately.' Follow-up: orthopaedic review in 1 week.

How examiners mark this station

Examiners will focus heavily on Domain 3 (Interpersonal Skills): how sensitively you deliver the news, whether you give a warning shot, allow silence, and respond to emotion. Domain 2 (Clinical Management) assesses the accuracy and clarity of information provided and the appropriateness of the plan discussed. Domain 1 (Data Gathering) assesses whether you established prior knowledge and readiness.

Domain 1 (Supporting)

Scores well: Fracture type explained. Stability assessed. Neurovascular status checked. Bladder function monitored.

Costs marks: Not explaining fracture type. Not checking neurovascular status.

Domain 2 (Primary focus)

Scores well: Conservative management explained. Analgesia plan. Physiotherapy. Recovery timeline with milestones. Follow-up imaging.

Costs marks: Not explaining management. No timeline. No follow-up.

Domain 3 (Primary focus)

Scores well: Leading with reassurance. Addressing parental guilt. Specific recovery milestones. Clear, calm communication.

Costs marks: Leading with injury. Not addressing guilt. Vague about recovery.

Common examiner feedback (and how to fix it)

Did not demonstrate sensitivity when delivering difficult information

Fix: Always give a warning shot. Deliver the key information in one clear sentence, then stop. Allow silence. Respond to emotion before giving more detail.

Did not sufficiently recognise or respond to the patient's feelings, concerns, or expectations

Fix: After delivering bad news, your primary role shifts to emotional support. Use the NURSE mnemonic (Name, Understand, Respect, Support, Explore) to respond to the patient's reaction.

Common mistakes in this station

  1. Leading with the injury before reassurance: saying 'pelvic fracture' before 'she is stable' causes unnecessary panic
  2. Not providing specific recovery milestones: parents need to know when school, activities, and sports can resume
  3. Not addressing parental guilt: the mother was supervising and feels responsible

Resitting PLAB 2?

If breaking bad news stations have been a weakness, practise the SPIKES framework until the structure is automatic. The most common resitter mistake is rushing past the emotional response. Allow genuine silence after delivering the news, and resist the urge to fill pauses with more information.

Example opening

Hello, my name is Dr [Name]. Thank you for coming in today. Before we start, can I ask if you have anyone with you, or would you like to have someone here? I have the results from your recent tests, and I'd like to go through them with you.

Frequently asked questions

What is the best way to structure breaking bad news about paediatric pelvic fracture?

Explaining a significant fracture in a child to a parent requires clear communication about the injury, treatment plan, and recovery, while managing the mother's distress. Emma (7) has a pelvic fracture from a cycling accident. Her mother Marlene is anxious.

Where are marks won and lost in this paediatric pelvic fracture station?

Examiners reward: Fracture type explained. Stability assessed. Neurovascular status checked. Bladder function monitored. Candidates are penalised for: Not explaining fracture type. Not checking neurovascular status.

Where do candidates most often go wrong in this station?

Leading with the injury before reassurance: saying 'pelvic fracture' before 'she is stable' causes unnecessary panic.

Can I do well in this station without real-world experience of paediatric pelvic fracture?

Structure beats experience here. Focus on children's bones heal faster than adults: important reassurance for paediatric fractures. Use the domain breakdown on this page to target your preparation, then practise the station aloud so your structure survives exam pressure.

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