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      Rapid Healing and Remodeling Process of Pediatric Seat-Belt Fracture without Surgical Treatment

      case-report

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          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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          Posterior instrumentation for thoracolumbar fractures.

          Mark R Mikles, Robert Stchur, Gregory Graziano (2015)
          Thoracolumbar fractures are relatively common injuries. Numerous classification systems have been developed to characterize these fractures and their prognostic and therapeutic implications. Recent emphasis on short, rigid fixation has influenced surgical management. Most compression and stable burst fractures should be treated nonsurgically. Neurologically intact patients with unstable burst fractures that have >25 degrees of kyphosis, >50% loss of vertebral height, or >40% canal compromise often can be treated with short, rigid posterior fusions. Patients with unstable burst fractures and neurologic deficits require direct or indirect decompression. Posterior stabilization can be effective with Chance fractures and flexion-distraction injuries that have marked kyphosis, and in translational or shear injuries. Advances in understanding both biomechanics and types of fixation have influenced the development of reliable systems that can effectively stabilize these fractures and permit early mobilization.
          Article 0 comments Cited 21 times – based on 0 reviews     Review now
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            Epidemiology of vertebral fractures in pediatric and adolescent patients

            Dominik Saul, Klaus Dresing (2018)
            Spinal injuries in children and adolescents are rare injuries, but consequences for the growing skeleton can be devastating. Knowledge of accident causes, clinical symptoms and diagnostics should be part of every trauma department treating these patients. We retrospectively analyzed patients with radiographically proven vertebral fractures of the spine. After clinical examination and tentative diagnosis the fractures and injuries were proven with conventional X-ray, computed tomography (CT) scans or magnetic resonance imaging (MRI). The study included 890 fractures in 546 patients with an average age of 12.8±6.2 (6.6-19.4) years. Females had an average age of 13.7±6.3 (7.4-20.0) years, whereas males were on average 12.0 (6.0-18.0) years old. Fall from height (58%) was the main cause of accident and the most common region of fracture was the thoracolumbar spine with a shift towards the thoracic spine the more fractures occurred. Merely 3.7% of all patients required operative treatment. If a vertebral fracture is found in children and adolescents, it is highly recommended to exclude synchronous additional spine fractures in other levels; prevention should concentrate on fall and traffic accidents.
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              Thoracolumbar Injury Classification and Severity Score in children: a reliability study.

              Ross L. Dawkins, Joseph H Miller, Omar I Ramadan … (2018)
              OBJECTIVE There are many classification systems for injuries of the thoracolumbar spine. The recent Thoracolumbar Injury Classification and Severity Score (TLICS) has been shown to be a reliable tool for adult patients. The aim of this study was to assess the reliability of the TLICS system in pediatric patients. The validity of the TLICS system is assessed in a companion paper. METHODS The medical records of pediatric patients with acute, traumatic thoracolumbar fractures at a single Level 1 trauma center were retrospectively reviewed. A TLICS was calculated for each patient using CT and MRI, along with the neurological examination recorded in the patient's medical record. TLICSs were compared with the type of treatment received. Five raters scored all patients separately to assess interrater reliability. RESULTS TLICS calculations were completed for 81 patients. The mean patient age was 10.9 years. Girls represented 51.8% of the study population, and 80% of the study patients were white. The most common mechanisms of injury were motor vehicle accidents (60.5%), falls (17.3%), and all-terrain vehicle accidents (8.6%). The mean TLICS was 3.7 ± 2.8. Surgery was the treatment of choice for 33.3% of patients. The agreement between the TLICS-suggested treatment and the actual treatment received was statistically significant (p < 0.0001). The interrater reliability of the TLICS system ranged from moderate to very good, with a Fleiss' generalized kappa (κ) value of 0.69 for the TLICS treatment suggestion among all patients; however, interrater reliability decreased when MRI was used to contribute to the TLICS. The κ value decreased from 0.73 to 0.57 for patients with CT only vs patients with CT/MRI or MRI only, respectively (p < 0.0001). Furthermore, the agreement between suggested treatment and actual treatment was worse when MRI was used as part of injury assessment. CONCLUSIONS The TLICS system demonstrates good interrater reliability among physicians assessing thoracolumbar fracture treatment in pediatric patients. Physicians should be cautious when using MRI to aid in the surgical decision-making process.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Neurotrauma
                Journal ID (iso-abbrev): Korean J Neurotrauma
                Journal ID (publisher-id): KJN
                Title: Korean Journal of Neurotrauma
                Publisher: Korean Neurotraumatology Society
                ISSN (Print): 2234-8999
                ISSN (Electronic): 2288-2243
                Publication date (Print): October 2018
                Publication date (Electronic): 31 October 2018
                Volume: 14
                Issue: 2
                Pages: 169-172
                Affiliations
                Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.
                Author notes
                Address for correspondence: Suk Hyung Kang. Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon 24253, Korea. Tel: +82-33-240-5173, Fax: +82-33-242-9970, nscharisma@ 123456hanmail.net
                Article
                DOI: 10.13004/kjnt.2018.14.2.169
                PMC ID: 6218343
                PubMed ID: 30402440
                SO-VID: f54544ef-64a1-480b-9799-1a4775760350
                Copyright © Copyright © 2018 Korean Neurotraumatology Society
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 12 July 2018
                Date revision received : 07 September 2018
                Date accepted : 27 September 2018
                Categories
                Subject: Case Report

                Keywords: conservative manage,fracture healing,pediatric injury,seat-belt injury
                Data availability:
                Keywords: conservative manage, fracture healing, pediatric injury, seat-belt injury

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