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Hirata H, Morimoto T, Tsukamoto M, Kobayashi T, Yoshihara T, Toda Y, Mawatari M. Pediatric chance fracture with seatbelt syndrome: A case report. Clin Case Rep 2023; 11:e7886. [PMID: 37744616 PMCID: PMC10514375 DOI: 10.1002/ccr3.7886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Key Clinical Message Prompt recognition and accurate diagnosis of seatbelt-related injuries such as Chance fractures are crucial for pediatric patients. Clinicians should be aware of the unique characteristics of children, including the presence of growth plates, and use advanced imaging techniques such as magnetic resonance imaging to guide appropriate treatment and minimize complications. Abstract Seatbelt-related injuries, known as the "seatbelt syndrome," encompass various injuries resulting from automobile accidents, including vertebral fractures, abdominal injuries, and great vessel traumas. Seatbelt signs include bruising or peeling of the anterior chest or abdominal wall, indicating abdominal pressure against the seatbelt. Chance fractures are a type of vertebral fracture characterized by fracture lines through multiple vertebral structures and are often associated with seatbelt injuries in adults. However, the unique features of Chance fractures in pediatric patients, such as the presence of growth plates, require a comprehensive diagnostic approach using advanced imaging techniques, including magnetic resonance imaging (MRI). This case report highlights the complexity of seatbelt-related injuries in children and emphasizes the importance of accurate diagnosis and multidisciplinary management. Understanding these factors can improve clinical knowledge and outcomes in children with seatbelt-related injuries.
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Affiliation(s)
- Hirohito Hirata
- Department of Orthopaedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Masatsugu Tsukamoto
- Department of Orthopaedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Takaomi Kobayashi
- Department of Orthopaedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Tomohito Yoshihara
- Department of Orthopaedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Yu Toda
- Department of Orthopaedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
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Park MS, Kang SH, Cho YJ, Yang JS. Rapid Healing and Remodeling Process of Pediatric Seat-Belt Fracture without Surgical Treatment. Korean J Neurotrauma 2018; 14:169-172. [PMID: 30402440 PMCID: PMC6218343 DOI: 10.13004/kjnt.2018.14.2.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/07/2018] [Accepted: 09/27/2018] [Indexed: 11/22/2022] Open
Abstract
Pediatric seat-belt fracture is a rare condition, and its management has not been well defined. The authors report a case of pediatric Chance fracture that was managed conservatively and that demonstrated rapid bone healing. A 7-year-old boy presented with back pain after a motor vehicle accident. Plain lumbar spine radiography, three-dimensional computed tomography (CT), and magnetic resonance imaging revealed a seat-belt fracture type C (classified by Rumball and Jarvis), and the patient's condition was managed conservatively. The patient started to ambulate with a brace 2 weeks after the injury. Spine CT performed 100 days after the injury revealed a remodeled fracture, and dynamic radiography did not show any evidence of instability or kyphotic deformity. We suggest that if there are no neurological deficits or severe deformities, then a pediatric seat-belt fracture should be managed conservatively, because the bone healing process is far more rapid in children than it is in adults and because of possible growth problems after surgery.
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Affiliation(s)
- Mu-Seung Park
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Suk Hyung Kang
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Yong Jun Cho
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Jin Seo Yang
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
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3
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Cassar-Pullicino VN, Leone A. Imaging in paediatric spinal injury. TRAUMA-ENGLAND 2017. [DOI: 10.1177/1460408617725781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Paediatric spinal injury is rare and exhibits many unique features. Attending clinicians and radiologists often lack knowledge, expertise and experience in dealing with a potential injury to the paediatric spine. Within the paediatric age range itself there are different age-dependent mechanisms that can injure the paediatric spine. Moreover, the anatomical features and degree of osseous maturity of the developing paediatric spine determine the biomechanical characteristics which promote unique patterns of spinal injury in each paediatric age group. Methods An expert illustrated narrative review of the literature. Results Multiple factors make the imaging interpretation of the injured paediatric spine challenging. Each imaging modality has strengths and weaknesses in depicting spinal anatomy which vary with the type of spinal injury and age of the paediatric patient. Conclusions Attending doctors need to be familiar with the imaging appearances of the normal paediatric spine, its normal variants as well as the imaging features characteristics of paediatric spinal injury seen on radiographs, computed tomography and magnetic resonance imaging.
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Affiliation(s)
| | - Antonio Leone
- Institute of Radiology, School of Medicine, Catholic University, Rome, Italy
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Schiedo RM, Lavelle W, Ordway NR, Rustagi T, Sun MH. Purely Ligamentous Flexion-Distraction Injury in a Five-Year-Old Child Treated with Surgical Management. Cureus 2017; 9:e1130. [PMID: 28473948 PMCID: PMC5415381 DOI: 10.7759/cureus.1130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Chance fractures by definition are a type of flexion-distraction injury with concomitant vertebral body fracture. Although uncommon in the pediatric population, they are associated with motor vehicle accidents and typically involve the thoraco-lumbar spine. Injury occurs when the spine rotates about a fixed axis, such as a lap belt. Our case reports the management of a five-year-old girl involved in a head-on collision who suffered a purely ligamentous flexion-distraction injury (Chance-type injury, without bone involvement) at the L2-L3 vertebral level. Previously these injuries were managed conservatively with serial casting; however, we present a case in which surgical management was used. A five-year-old girl sustained multiple injuries after being involved in a high-speed motor vehicle accident. At presentation, there was obvious abdominal bruising with a seat-belt sign and marked kyphosis of the spine with severe tenderness at the L2-L3 level. She required immediate exploratory laparotomy for her intraabdominal injuries. After stabilization, an orthopedic consult was deemed necessary. She was found to have occipital-cervical injury with mild anterolisthesis of C2 on C3 and disruption of the apical ligament. There was evidence of bilateral dislocation of the L2-L3 facet joints with marked disruption of the posterior ligaments and a hematoma sack. She required open reduction and internal fixation with an L2-L3 laminectomy, pedicle screw and rod placement. The kyphotic deformity was reduced using a compression device and stable alignment was achieved intraoperatively. This was a rare and difficult case with limited evidence on the appropriate management of such an injury. Due to the severe instability of her injury, a surgical approach was taken. At two years postoperative, the patient is neurologically intact and pain free. Imaging revealed stable alignment of her lumbar hardware. Ultimately, this has resulted in an excellent outcome at the current follow-up.
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Affiliation(s)
- Ryan M Schiedo
- Medical Student, Suny Upstate Medical University, Syracuse, NY
| | - William Lavelle
- Department of Orthopedic Surgery, Suny Upstate Medical University, Syracuse, NY
| | - Nathaniel R Ordway
- Department of Orthopedic Surgery, Suny Upstate Medical University, Syracuse, NY
| | - Tarush Rustagi
- Department of Orthopedic Surgery, Suny Upstate Medical University, Syracuse, NY
| | - Mike H Sun
- Department of Orthopedic Surgery, Suny Upstate Medical University, Syracuse, NY
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Suzuki S, Fujita N, Hikata T, Iwanami A, Ishii K, Nakamura M, Matsumoto M, Watanabe K. Asymmetrical pedicle subtraction osteotomy for progressive kyphoscoliosis caused by a pediatric Chance fracture: a case report. SCOLIOSIS AND SPINAL DISORDERS 2017; 12:8. [PMID: 28331905 PMCID: PMC5351051 DOI: 10.1186/s13013-017-0115-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 02/27/2017] [Indexed: 11/10/2022]
Abstract
Background Although most pediatric Chance fractures (PCFs) can be treated successfully with casting and bracing, some PCFs cause progressive spinal deformities requiring surgical treatment. There are only few reports of asymmetrical osteotomy for PCF-associated spinal deformities. Case presentation We here report a case of a 10-year-old girl who suffered an L2 Chance fracture from an asymmetrical flexion-distraction force, accompanied by abdominal injuries. She was treated conservatively with a soft brace. However, a progressive spinal deformity became evident, and 10 months after the injury, examination showed segmental kyphoscoliosis with a Cobb angle of 36°, a kyphosis angle of 31°, and a coronal imbalance of 30 mm. Both the coronal and sagittal deformities were successfully corrected by asymmetrical pedicle subtraction osteotomy. Conclusions Initial kyphosis and posterior ligament complex should be evaluated at some point when treating PCFs. Asymmetrical pedicle subtraction osteotomy can be a useful surgical option when treating rigid kyphoscoliosis associated with a PCF.
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Affiliation(s)
- Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan
| | - Tomohiro Hikata
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan
| | - Akio Iwanami
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan
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Abstract
INTRODUCTION While the use of vehicular restraints has reduced the morbidity and mortality of children involved in motor vehicle collisions (MVC), to our knowledge, no study has examined the relationship between restraint type and patterns of pediatric spinal injuries. The purpose of this study is to evaluate this association and review the spinal injuries sustained in children involved in MVC. METHODS We completed an IRB-approved, retrospective chart review of all patients below 10 years of age presenting to a level 1 pediatric trauma hospital with spine injuries sustained in MVC from 2003 to 2011. We reviewed prehospital data, medical records, and radiographs to establish the restraint type and characterize the spinal injuries sustained. RESULTS A total of 97 patients were identified with spinal trauma secondary to MVC with appropriate and documentation of restraint type. Results are reported regardless of whether the restraint employed was properly used per established guidelines. Car seat/booster seat (C/B) patients sustained significantly higher rates of cervical spine (62%) and ligamentous (62%) injuries than the 2-point (2P) (10%) and 3-point (3P) restraint (24%) groups (P<0.001). Two-point and 3P restraint use was associated with significantly higher rates of thoracolumbar injuries (67% and 62%, respectively) than the C/B (14%) and unrestrained (0%) groups (P<0.001). Two-point and 3P passengers also had a higher rate of flexion-distraction injuries (P<0.001). Patients in the unrestrained group sustained a significantly higher rate of cervical spine (80%) and ligamentous (40%) injuries than the 2P and 3P groups (P<0.001). No differences were found in the type or location of injury between the 2P and 3P groups. Significant differences in proper restraint use were identified between age groups with younger children demonstrating higher rates of proper restraint use (P<0.01). CONCLUSIONS Two-point or 3P seatbelt use is associated with lower rates of cervical spine trauma but higher rates of thoracic and lumbar trauma, particularly flexion-distraction injuries, when compared with car or booster seats. Children in C/B and those who are unrestrained sustain high rates of cervical spine injury. LEVEL OF EVIDENCE Level III-prognostic study.
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Hollow-organ perforation following thoracolumbar spinal injuries of fall from height. Int J Surg Case Rep 2015; 11:110-112. [PMID: 25967553 PMCID: PMC4446694 DOI: 10.1016/j.ijscr.2015.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 11/23/2022] Open
Abstract
We describe two cases of Hollow-organ perforation following thoracolumbar injury. All patient have mild inferior motoric parapareses 4/5 and 3/5 also complaint diffusely abdominal tenderness. The mechanism of hollow organ perforation. The mechanism of hollow organ perforation following blunt thoracoabdominal is the theory suggests that these injuries may arise due to the shear stress exerted on the hollow organ wall.
Introduction Spinal trauma is the cause of high mortality and morbidity, the fall from height as mechanism that can cause a wide variety of lesions, associated both with the direct impact on the ground and with the deceleration. In such fall cases greater heights and higher mortality are involved. Presentation of case We report the successful management of life-threatening hollow-organ perforation following thoracolumbar spinal injury. Discussion Perforation of the hollow-organ in the setting of thoracolumbar trauma may delay the diagnosis and can have devastating consequences. Conclusions This case supports the recommendation for neurosurgeon in the setting of thoracolumbar injury that perforation of the hollow-organ can have devastating consequences. It is vital to achieve an early diagnosis to improve survival rate.
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Knox JB, Wimberly RL, Riccio AI. Pediatric lateral distraction injury of the lumbar spine: a case report. Spine J 2013; 13:e45-8. [PMID: 23773432 DOI: 10.1016/j.spinee.2013.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 02/22/2013] [Accepted: 05/04/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lateral distraction injuries represent a very rare pattern of injury with only five cases reported in the literature. Such injuries are a result of high-energy trauma and have a high association with severe concomitant injuries. All previous reports of this injury are in skeletally mature individuals, and this has not been previously described in young children. PURPOSE To report a case of a lateral distraction injury in a young child secondary to improper seat belt use. STUDY DESIGN Case report and review of the literature. PATIENT SAMPLE Case report of an 8-year-old girl involved in a highway speed head-on collision. METHODS We report here on an 8-year-old girl who was lying supine in the backseat of a motor vehicle while wearing a lap belt when the vehicle was involved in a high-speed motor vehicle crash. She presented with focal back pain, abdominal pain, and a seat belt sign. Imaging demonstrated focal coronal plane deformity with unilateral ligamentous disruption. The patient was diagnosed with a ligamentous lateral distraction injury of the lumbar spine. This injury was treated with open reduction and posterior spinal fusion with pedicle screw fixation. RESULTS The patient tolerated the procedure well and had an uneventful postoperative course. CONCLUSIONS In this case, we describe a lateral distraction injury in a young child secondary to improper seat belt use. This represents the first description of such an injury in this age group, and this case highlights the spectrum of injury caused by improper seat belt use in the pediatric population.
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Affiliation(s)
- Jeffrey B Knox
- Department of Orthopaedic Surgery, Tripler Army Medical Center, 1 Jarrett White Rd, Honolulu, HI 96859, USA.
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9
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Abstract
Flexion-distraction injuries represent an uncommon pattern of injury in the pediatric population. Although this is a well-studied topic in adults, the literature on such injuries in children and adolescents is relatively sparse, with only low levels of evidence available to guide treatment. These injuries carry a high rate of concomitant injuries and a high morbidity and mortality in this population. Proper understanding of these complex injuries is important to ensure proper management and avoid complications.
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Affiliation(s)
- Jeffrey Bruce Knox
- Orthopedic Surgery Service, Tripler Army Medical Center, Honolulu, HI 96859, USA.
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10
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Abstract
BACKGROUND Chance fractures or flexion-distraction injuries of the spine are uncommon in children. Previous reports have been limited to isolated case reports or very small retrospective series. This is the largest series reported in the English literature. METHODS This was a multicenter retrospective review of pediatric Chance fractures treated at 3 large level-1 pediatric trauma centers. We analyzed the demographics, causes, circumstances, treatment, complications, and clinical outcome of 35 patients younger than 18 years old with a Chance fracture. We hypothesize that surgical treatment provides the best results. RESULTS There were 20 females and 15 males, with an average age of 9 years (range, 1.6 to 17 y). The most common level of injury was at L2 and L3 (20/35). Fifteen children (43%) had a neurological deficit at the time of injury and only 8 fully recovered. One patient deceased before formal orthopaedic treatment. Patients were treated at the discretion of the surgeon and the surgically treated group (20/34) had greater initial kyphotic deformity (22 degrees) than those treated nonoperatively (14/34; 11.4 degrees) and less posttreatment residual kyphotic deformity (3.5 vs. 20 degrees, respectively). The complication rate related to treatment was 26% (9/34) and most complications in the nonoperative group were related to progression of kyphosis whereas in the surgical group most complications are related to discomfort over the hardware (4 patients). Fifteen children (43%) had neurological deficit at presentation, 7 did not fully recover, for an incidence of permanent neurologic deficit of 10% among restrained patients versus 42% for unrestrained patients. Twenty-one patients (62%) had a good final clinical outcome defined by no chronic pain or neurologic deficit, this represented 45% good outcome in the nonoperative group compared with 84% in the operative group (NS). CONCLUSIONS In this multicenter retrospective study, surgical treatment of Chance fractures in children seems to produce better clinical outcome, the appropriate use of restraints reduce the incidence of definitive neurologic deficit. LEVEL OF EVIDENCE Level 3, comparative study.
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Abstract
Injuries are the most common cause of death for Canadians aged one to 18 years, and 50% of injury deaths in this age group involve an automobile. Evidence suggests that 71% reduction in deaths and a 67% reduction in injuries can be achieved when child safety seats are used properly. This article reviews the recommended restraints for children by weight group and describes the proper position for children. Detailed case examples of car crashes are described to illustrate the dangers of incorrectly used or no restraint.
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Affiliation(s)
- A W Howard
- The Hospital for Sick Children, Toronto, Ontario
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12
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An unusual combination of a lumbar seat belt injury and hemorrhagic contusion of the lower thoracic cord in a 2-year-old child: a case report. J Pediatr Orthop B 2010; 19:98-101. [PMID: 19829157 DOI: 10.1097/bpb.0b013e32832f06a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe a previously unreported combination of lumbar flexion-distraction ligamentous disruption and incomplete thoracic spinal cord injury in a 2-year-old boy. Magnetic resonance imaging of the thoracolumbar spine showed hemorrhagic cord contusion at the T11-T12 level. Plain radiographs showed mild kyphosis of the L3-L4 segment. Fluoroscopy showed pathological motion at L3-L4 in flexion indicating a ligamentous injury. The lumbar spine was surgically stabilized and at 1-year follow-up, a remarkable neurological recovery was noted. We believe that physicians managing children with multiple trauma injuries should be aware of this rare type of injury that might be underdiagnosed.
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Surgical management of severely displaced pediatric seat-belt fracture-dislocations of the lumbar spine associated with occlusion of the abdominal aorta and avulsion of the cauda equina: a report of two cases. Spine (Phila Pa 1976) 2008; 33:E325-8. [PMID: 18449033 DOI: 10.1097/brs.0b013e31816f6c56] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To present 2 cases of fracture-dislocations of the lumbar spine associated with injury to the aorta and avulsion of the cauda equina and present recommendations regarding urgent management of these injuries. SUMMARY OF BACKGROUND DATA The "seat-belt syndrome" was first described by Garrett and Braunstein in 1962 to describe intraabdominal visceral injuries with fractures of the lumbar spine. Although this syndrome has been described in previously, there have been no reported cases of pediatric patients with significant injury to the abdominal aorta. METHODS We present 2 seat-belt injuries occurring within a 4 month period at a pediatric trauma center with significantly displaced lumbar fracture-dislocation, abdominal aortic occlusion, and complete neurologic injury. RESULTS Rigid fixation of the spinal fracture dislocation in both cases was delayed since these patients were deemed to be hemodynamically unstable. Aggressive mobilization, wound care, and pulmonary toilet were possible after stabilization of the spine. Despite this, 1 patient eventually died. CONCLUSION These cases need to be managed according to principles established in the treatment of extremity fractures with vascular and neurologic injuries. That is, early rigid fixation of the fracture to protect the vascular repair.
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Abstract
STUDY DESIGN Observational. OBJECTIVE The authors present a detailed description of 25 skeletally immature patients with Chance fractures with a mean follow-up of 6.4 years. SUMMARY OF BACKGROUND DATA Since the legislation mandating seat belt usage in Canada was first introduced, the fatality rate of automobile collisions has decreased significantly. However, seat belts do not result in the complete elimination of injury. Fractures of the lumbar spine due to seat belts are well recognized in adolescents and adults but there are few reports in young children. METHODS Radiographic images and patient records were analyzed for information on patient demographics and injury details. RESULTS Treatment involved either posterior instrumentation (n = 16) or a conservative approach using casting or bracing (n = 9). Concomitant injuries were documented. A deformity index was developed as a simple value to take into account the severity of both anterior loss of vertebral height and posterior distraction. CONCLUSION The deformity index was significantly higher in patients with a concomitants abdominal injury and significantly higher in patients managed operatively. Functional outcome scores were completed on 14 of the patients. Patients scored within the reported norms on the SF-36 version 2 but scored poorly on the pain and disability component of the AAOS lumbar specific questionnaire. These outcomes indicate a need for using an injury specific score to accurately quantify disability.
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Abstract
STUDY DESIGN Retrospective case review. OBJECTIVE This study aims to characterize a broad spectrum of spinal injuries, from minor soft tissue injuries to spinal cord injuries. We hypothesized that the pattern of pediatric spinal injury would depend on age and cause. SUMMARY OF BACKGROUND DATA While pediatric spinal trauma is generally considered to be rare, the impact of serious spinal trauma is considerable, both in medical and socioeconomic terms. Comparison of serious and minor injuries has rarely been carried out for pediatric spinal injury cases. METHODS All children up to age 16 who sustained spinal trauma, as defined by ICD10 codes, at 2 pediatric trauma hospitals in Sydney, Australia were identified (N = 340). Data on injury mechanism (defined as the causative event), type, and spinal level were collected and analyzed using logistic regression. RESULTS Traffic-related incidents accounted for approximately one third of all spinal trauma and half of serious injuries. The cervical spine was the most frequently injured region, with thoracic and lumbar spine injuries becoming more common with age. The upper cervical spine was more commonly seriously injured in young children, and the lower cervical spine was involved more often in older children. The frequency of minor soft tissue neck injuries increased substantially above the age of 8. Serious spinal injury is more likely to occur in conjunction with multiple trauma. Road traffic incidents were more likely to result in serious spinal injury than falls or sporting incidents. CONCLUSION This study has shown that the pattern of spinal injury in children is related to age and also the mechanism of injury. While traffic-related incidents are a leading cause of injury across all age groups, emphasis on fall prevention is needed for younger children. Older children, particularly boys, are sustaining spinal trauma in sporting and recreational activities.
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Affiliation(s)
- Lynne E Bilston
- Prince of Wales Medical Research Institute, University of NSW, Randwick, NSW, Australia.
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Papavasiliou A, Stanton J, Sinha P, Forder J, Skyrme A. The complexity of seat belt injuries including spinal injury in the pediatric population: a case report of a 6-year-old boy and the literature review. Eur J Emerg Med 2007; 14:180-3. [PMID: 17473618 DOI: 10.1097/mej.0b013e32801430e2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present, along with a literature review, the case report of a 6-year-old boy, involved in a high-speed motor vehicle accident, who sustained a seat belt injury of the lumbar spine. We discuss the clinical presentation of thoracolumbar fractures in children, the sensitivity of clinical examination and radiographic evaluation and the associated abdominal injuries that are commonly present with seat belt spinal injuries. Computerized tomography is limited in the detection of soft tissue spinal fractures because these fractures occur in the plain of the section. Plain lateral x-rays of the lumbar spine and computerized tomographic three-dimensional reconstruction images can be helpful but they cannot evaluate the extent of the soft tissue injury. The magnetic resonance imaging scan is the best diagnostic tool to provide the diagnosis.
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Affiliation(s)
- Athanasios Papavasiliou
- Department of Trauma and Orthopaedic, East Sussex Hospitals NHS Trust, Eastbourne District General Hospital, Eastbourne, UK.
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de Gauzy JS, Jouve JL, Violas P, Guillaume JM, Coutié AS, Chaumoitre K, Launay F, Bollini G, Cahuzac JP, Accadbled F. Classification of chance fracture in children using magnetic resonance imaging. Spine (Phila Pa 1976) 2007; 32:E89-92. [PMID: 17224805 DOI: 10.1097/01.brs.0000252092.27345.1a] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN MRI study of pediatric Chance fracture. OBJECTIVE To evaluate bone and soft tissue lesions in pediatric Chance fracture. SUMMARY OF BACKGROUND DATA Several descriptions and classifications have been already developed for Chance fracture, but mainly for adult. Furthermore, they are all based only on radiographic studies. METHODS MRI and radiographs of 18 children with Chance fracture were analyzed before treatment. RESULTS On MRI, in all cases, no abnormal signs were noted on the intervertebral disc. Six patients had a bone fracture going through the pedicle and the vertebral body. Twelve patients had a physeal injury located on the superior or on the inferior vertebral endplate. Three types of lesions could be identified according to the location of the lesion in relation to the pedicle. CONCLUSION MRI is useful in the diagnosis of pediatric Chance fracture. It allows physeal injury to be clearly identified from disc injury.
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Affiliation(s)
- Jérôme Sales de Gauzy
- Service d'Orthopédie Pédiatrique, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
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Abstract
Pediatric spine injuries are rare, not only due to the plasticity of the pediatric spine, but also due to the difficulty of diagnosis and the usually severe, if not fatal, associated injuries. Mechanisms of injury, transportation, initial management, diagnostic exams, and management of such lesions are different from those of the adult, and an individualized approach to each case, looking for specific injury patterns, avoids misdiagnosis. The goal of this manuscripts is to summarize the specific spinal injury patterns of the pediatric population, as well as the present literature regarding their diagnosis and treatment.
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Affiliation(s)
- Luiz R Vialle
- Cajuru University Hospital, Catholic University of Parana, Curitiba, Brazil.
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Betz RR, Mulcahey MJ, D'Andrea LP, Clements DH. Acute evaluation and management of pediatric spinal cord injury. J Spinal Cord Med 2005; 27 Suppl 1:S11-5. [PMID: 15503697 DOI: 10.1080/10790268.2004.11753779] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Of new spinal cord injuries (SCIs) throughout North America, up to 14% occur in children younger than 15 years of age. The purpose of this paper is to present several aspects unique to the evaluation and treatment of a child with SCI. EVALUATION Vital signs may be absent along with minimal blood loss, indicating upper cervical spine injury that is common in children. Lap belt injuries are more prevalent in children, especially since 1984, when seat belt laws were enacted, and more children began using a lap belt but no shoulder harness. Of children with lap belt injuries, 4% to 39% have significant neurologic injuries, and 30% to 50% have associated retroperitoneal injuries. Radiographic evaluation is more challenging in children because of the presence of normal variants such as C2-C3 pseudosubluxation, which occurs in 9% of children younger than 7 years. SCI without radiographic abnormality (SCIWORA) is common in children under 10 years of age and is associated with more complete neurologic injuries than in cases where the injuries can be seen on radiograph. MANAGEMENT For transportation of children and infants younger than 6 years of age, the cervical spine needs to be in a neutral position, and spine boards need to be modified to allow for the larger head-to-torso ratio that is present in children. Cervical traction with Crutchfield tongs in children <12 years of age is associated with dural leaks, and therefore, the use of halo traction with modified pin placements is recommended. Indications for surgery are generally the same as those for adults in regard to decompression and alignment. The length of a spinal fusion for stabilization should be minimized in the thoracolumbar spine because of the potential for premature arrest of spinal growth. SUMMARY The differences between children and adults with acute SCI are significant enough that caregivers cannot evaluate and treat a child with SCI as they would a small adult.
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Affiliation(s)
- Randal R Betz
- Shriners Hospitals for Children, Philadelphia, Pennsylvania 19140, USA.
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20
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Ceroni D, Mousny M, Lironi A, Kaelin A. Pediatric seatbelt injuries: unusual Chance's fracture associated with intra-abdominal lesions in a child. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2004; 13:167-71. [PMID: 12856196 PMCID: PMC3476573 DOI: 10.1007/s00586-003-0559-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2002] [Revised: 03/14/2003] [Accepted: 03/21/2003] [Indexed: 11/30/2022]
Abstract
The authors report the case of a 7-year-old child involved in a motor vehicle accident. She sustained an unusual flexion-distraction vertebral injury. This spinal injury was related to seatbelt use and was associated with intra-abdominal lesions. The spinal lesion consisted of a posterior ligamentous disruption with widening of the posterior intervertebral space at two adjacent lumbar levels. The purpose of this case report is to describe an atypical and perhaps often unrecognized spinal lesion and to explain our approach to diagnosis and treatment.
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Affiliation(s)
- D Ceroni
- Paediatric Orthopaedic Unit, Children's Hospital, University Hospital Geneva, Rue Willy Donzé 6, 1205 Geneva, Switzerland.
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21
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Affiliation(s)
- J Griffet
- Chirurgie infantile, hôpital de l'Archet, 151, route de Saint-Antoine-de-Ginestière, BP 3079, 06202 Nice cedex 3, France.
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22
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Affiliation(s)
- Lee S Segal
- Department of Orthopedics and Rehabilitation, The Pennsylvania State University College of Medicine, Hershey 17033, USA
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23
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Lynch JM, Meza MP, Pollack IF, Adelson PD. Direct injury to the cervical spine of a child by a lap-shoulder belt resulting in quadriplegia: case report. THE JOURNAL OF TRAUMA 1996; 41:747-9. [PMID: 8858040 DOI: 10.1097/00005373-199610000-00026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Most pediatric cervical spine injuries from seat-belt restraints result from hyperflexion of the neck without direct injury to the spine from the restraining device. We report what we believe to be the first case of direct injury to the cervical spine by the shoulder component of a lap-shoulder seat belt. This resulted in quadriplegia. The mechanism of injury and recommendations to obviate such injuries are discussed.
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Affiliation(s)
- J M Lynch
- Benedum Pediatric Trauma Program, Children's Hospital of Pittsburgh, PA 15213, USA
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24
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Abstract
Passenger restraints reduce fatalities and serious injuries. Restraint systems alter the distribution of injuries seen in accident victims, and they cause a number of injuries. The distribution of injuries is dependent on the type of restraint. Automatic motorized shoulder belts are being used without the accompanying manual lap belt. This greatly reduces the effectiveness of the system and is equal to the two-point shoulder belt of the 1960s. Airbag injuries include abrasions to the face, neck, and chest; minor burns to the upper extremities; and chemical keratitis. Airbags have been shown to reduce injuries overall, especially when used in conjunction with a lap and shoulder belt. Elderly patients incur more rib and sternal fractures due to seat belts than do younger patients. Nevertheless, restraint systems are effective at reducing serious internal injuries in this population. Children who are too large for child safety seats but too small for adult seat belts are at increased risk for injury. Improvement in restraint systems for children in this age range is recommended. All pregnant women should be encouraged to wear seat belts because they reduce maternal injuries, and there is no evidence that they increase the risk of fetal loss. In view of the injury reduction associated with passenger restraint systems, emergency physicians should emphasize to their patients the importance of wearing seat belts.
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Affiliation(s)
- G W Hendey
- Valley Medical Center, Fresno, California
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