Spine Fractures in Children and Adolescents—Frequency, Causes, Diagnostics, Therapy and Outcome—A STROBE-Compliant Retrospective Study at a Level 1 Trauma Centre in Central Europe

The aim of this study was to present the frequencies and characteristics of paediatric spine fractures, focusing on injury mechanisms, diagnostics, management, and outcomes. This retrospective, epidemiological study evaluated all patients aged 0 to 18 years with spine fractures that were treated at a level 1 trauma centre between January 2002 and December 2019. The study population included 144 patients (mean age 14.5 ± 3.7 years; 40.3% female and 59.7% male), with a total of 269 fractures. Common injury mechanisms included fall from height injuries (45.8%), with an increasing prevalence of sport incidents (29.9%) and a decreasing prevalence of road incidents (20.8%). The most common localisation was the thoracic spine (43.1%), followed by the lumbar spine (38.2%), and the cervical spine (11.8%). Initially, 5.6% of patients had neurological deficits, which remained postoperatively in 4.2% of patients. Most (75.0%) of the patients were treated conservatively, although 25.0% were treated surgically. A small proportion, 3.5%, of patients presented postoperative complications. The present study emphasises the rarity of spinal fractures in children and adolescents and shows that cervical spine fractures are more frequent in older children, occurring with a higher rate in sport incidents. Over the last few years, a decrease in road incidents and an increase in sport incidents in paediatric spine fractures has been observed.

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Suture Versus Screw Fixation of Tibial Spine Fractures in Children and Adolescents: A Comparative Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119881961 ◽

2019 ◽

Vol 7 (11) ◽

pp. 232596711988196 ◽

Cited By ~ 4

Author(s):

Mark Callanan ◽

Judd Allen ◽

Brett Flutie ◽

Francis Tepolt ◽

Patricia E. Miller ◽

...

Keyword(s):

Children And Adolescents ◽

Surgical Outcomes ◽

Screw Fixation ◽

Cruciate Ligament ◽

Return To Sport ◽

Spine Fractures ◽

Avulsion Fractures ◽

Tibial Spine ◽

Intercondylar Eminence ◽

Fractures In Children

Background: Tibial spine fractures involve an avulsion injury of the anterior cruciate ligament (ACL) at the intercondylar eminence, typically in children and adolescents. Displaced fractures are commonly treated with either suture or screw fixation. Purpose: To investigate differences in various outcomes between patients treated with arthroscopic suture versus screw fixation for tibial spine avulsion fractures in one of the largest patient cohorts in the literature. Study Design: Cohort study; Level of evidence, 3. Methods: A search of medical records was performed with the goal of identifying all type 2 and type 3 tibial spine avulsion fractures surgically treated between 2000 and 2014 at a pediatric hospital. All patients had a minimum of 12 months clinical follow-up, suture or screw fixation only, and no major concomitant injury. Results: There were 68 knees in 67 patients meeting criteria for analysis. There were no differences with regard to postsurgical arthrofibrosis ( P = .59), ACL reconstruction ( P = .44), meniscal procedures ( P = .85), instability ( P = .49), range of motion ( P = .51), return to sport ( P >.999), or time to return to sport ( P = .11). Elevation of the repaired fragment on postoperative imaging was significantly greater in the suture group (5.4 vs 3.5 mm; P = .005). Postoperative fragment elevation did not influence surgical outcomes. The screw fixation group had more reoperations (13 vs 23; P = .03), a larger number of reoperations for implant removal (3 vs 22; P < .001), and nearly 3 times the odds of undergoing reoperation compared with suture patients (odds ratio, 2.9; P = .03). Conclusion: Clinical outcomes between suture and screw fixation were largely equivalent in our patients. Postoperative fragment elevation does not influence surgical outcomes. Consideration should be given for the greater likelihood of needing a second operation, planned or unplanned, after screw fixation.

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947 Children and adolescents admitted to a danish level 1 trauma centre 2002–2011

Injury Prevention ◽

10.1136/injuryprev-2016-042156.947 ◽

2016 ◽

Vol 22 (Suppl 2) ◽

pp. A337.1-A337

Author(s):

Danny Stefan Ekström ◽

Rasmus Hviid Larsen ◽

Jens Martin Lauritsen ◽

Christian Faergemann

Keyword(s):

Children And Adolescents ◽

Trauma Centre ◽

Level 1

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Gunshot-associated Fractures in Children and Adolescents Treated at Two Level 1 Pediatric Trauma Centers

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0000000000000401 ◽

2016 ◽

Vol 36 (1) ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Sameer M. Naranje ◽

Shawn R. Gilbert ◽

Matthew G. Stewart ◽

Jeremy K. Rush ◽

Craig A. Bleakney ◽

...

Keyword(s):

Children And Adolescents ◽

Pediatric Trauma ◽

Trauma Centers ◽

Fractures In Children ◽

Level 1

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Wirbelfrakturen im Wachstumsalter Spinal Fractures in Children and Adolescents

European Journal of Pediatric Surgery ◽

10.1055/s-2008-1075615 ◽

1987 ◽

Vol 42 (06) ◽

pp. 333-338

Author(s):

L Jani

Keyword(s):

Children And Adolescents ◽

Spinal Fractures ◽

Fractures In Children

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Treatment strategies for managing cervical spine injuries in rugby players

Surgical Neurology International ◽

10.25259/sni_794_2020 ◽

2021 ◽

Vol 12 ◽

pp. 6

Author(s):

Ratko Yurac ◽

Juan Jose Zamorano ◽

Guisela Quinteros ◽

Guillermo Izquierdo ◽

Felipe Novoa ◽

...

Keyword(s):

Cervical Spine ◽

Treatment Strategies ◽

Neurological Deficits ◽

Cervical Spine Fracture ◽

Spine Fractures ◽

X Rays ◽

Cervical Spine Injuries ◽

Cervical Spine Fractures ◽

Rugby Players ◽

Ct Studies

Background: Cervical spine fractures are potentially catastrophic injuries in rugby players. Here, we reviewed seven patients who sustained rugby-related cervical spine fractures. Notably, three of seven fractures were missed on initial X-rays, but were ultimately documented on CT studies obtained an average of 10 days later. Methods: Seven patients sustained cervical spine fracture attributed to rugby (2009–2016) and were followed an average of 52 posttrauma months. Most injuries occurred at the C6-C7 level, and six of seven patients required surgery. Further, only two of seven patients exhibited resultant neurological deficits (e.g., one myelopathy and one radiculopathy). Results: Although the rugby injury was sufficiently documented on initial X-rays in four patients, three initial X-rays missed fractures, which were documented on the CT studies obtained an average of 10 days later. Conclusion: Rugby-related cervical fractures must be considered where players continue to complain of pain following trauma. Notably, routine X-rays may miss fractures in 3 of 7 cases (43%), thus warranting supplemental CT examinations to definitively rule out fractures.

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Cervical Spine Fractures in Children

Evidence-Based Emergency Care ◽

10.1002/9781444300772.ch7 ◽

2009 ◽

pp. 59-61

Keyword(s):

Cervical Spine ◽

Spine Fractures ◽

Fractures In Children ◽

Cervical Spine Fractures

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Cervical Computed Tomography Angiography Rarely Leads to Intervention in Patients With Cervical Spine Fractures

Global Spine Journal ◽

10.1177/2192568219885897 ◽

2019 ◽

Vol 10 (8) ◽

pp. 992-997

Author(s):

Conor John Dunn ◽

Stuart Changoor ◽

Kimona Issa ◽

Jeffrey Moore ◽

Nancy J. Moontasri ◽

...

Keyword(s):

Computed Tomography ◽

Cervical Spine ◽

Computed Tomography Angiography ◽

Neurological Deficits ◽

Cervical Region ◽

Trauma Patients ◽

Spine Fractures ◽

Cervical Fractures ◽

Cervical Spine Fractures ◽

The Impact

Study Design: Retrospective cohort study. Objectives: To evaluate the impact of computed tomography angiography (CTA) in the management of trauma patients with cervical spine fractures by identifying high-risk patients for vertebral artery injury (VAI), and evaluating how frequently patients undergo subsequent surgical/procedural intervention as a result of these findings. Methods: All trauma patients with cervical spine fractures who underwent CTA of the head and neck at our institution between January 2013 and October 2017 were identified. Patients were indicated for CTA according to our institutional protocol based on the modified Denver criteria, and included patients with cervical fractures on scout CT. Those with positive VAI were noted, along with their fracture location, and presence or absence of neurological deficit on physical examination. Statistical analysis was performed and odds ratios were calculated comparing the relationship of cervical spine fracture with presence of VAI. Results: A total of 144 patients were included in our study. Of those, 25 patients (17.4%) were found to have VAI. Two patients (1.4%) with VAI underwent subsequent surgical/procedural intervention. Of the 25 cervical fractures with a VAI, 20 (80%), were found to involve the upper cervical region (4.2 OR, 95% CI 1.5-12.0; P = .007). Of the 25 who had a VAI, 9 were unable to undergo reliable neurologic examination. Of the remaining 16 patients, 5 (31.3%) had motor or sensory deficits localized to the side of the VAI, with no other attributable etiology. Conclusions: Cervical spine fractures located in the region of the C1-C3 vertebrae were more likely to have an associated VAI on CTA. VAI should also be considered in cervical trauma patients who present with neurological deficits not clearly explained by other pathology. Despite a finding of VAI, patients rarely underwent subsequent surgical or procedural intervention.

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