Thoracolumbar Fracture-Dislocation in Child Abuse: Case Report, Closed Reduction Technique and Review of the Literature

Abstract

There have been very few reports in the literature of management of thoracolumbar fracture dislocations in very young children. The following is a presentation of one of these rare cases that was treated using a closed reduction method that has been little described in the medical literature. A 14-month-old child suffered a fracture dislocation at T₁₂–L₁ from nonaccidental trauma. The patient was neurologically intact upon admission. Treatment consisted of closed manual reduction and hyperextension casting under sedation. At 22-month follow-up, the patient displayed excellent clinical and radiographic results and remained neurologically intact. The operative technique is presented in detail and relevant literature reviewed. We propose that closed reduction and extension casting may be an acceptable treatment for infantile thoracolumbar fracture dislocations in neurologically intact patients.

Yield of Radiographic Skeletal Surveys for Detection of Hand, Foot, and Spine Fractures in Suspected Child Abuse

“…Spinal injuries, even potentially devastating fracture-dislocations, generally manifest as anatomic alterations that are subtle or absent on frontal projections, despite gross displacement and malalignment on the lateral view. The presence of specific clinical indicators of spinal injury is variable, and a delay in diagnosis may risk the development of severe and permanent neurologic impairment [16,[19][20][21]. The potential loss of important diagnostic information by failing to identify spinal injuries is of significant concern, and, in our view, outweighs the dose reduction achievable by excluding the lateral views of the spine.…”

Fracturas torácicas y lumbares en los adolescentes. Estudio de ocho años

“…La tomografía computarizada ha reemplazado a las radiografías convencionales como la imagen de elección primaria en los pacientes traumatizados, debido a su alta agudeza diagnóstica y a su costo-beneficio, reduciendo el número excesivo de radiografías tomadas [9][10][11] . La columna vertebral en los niños tiene más tejido blando y más periostio comparados con los adultos, resultando en un mayor potencial para la reparación de sus lesiones, la remodelación ósea, la cicatrización de los ligamentos dañados y la recuperación del daño neurológico [12][13][14] . Una fractura de columna estable es una fractura con menos de 20° de deformidad en cifosis, con menos del 50% de pérdida de altura del cuerpo vertebral, con preservación de su columna posterior y sin déficit neurológico 15 .…”

Adjacent Segment Disease after the Fractured Lumbar Vertebrae Fusion

“…According to the reports of International Spinal Cord Injury Organizations and Associations, 40% of SCI is caused by motorcycle accidents [1,2], About 40% of SCI is associated with occupational and sport injuries and the rest 20% occurs due to fall from height [3,4]. Because of the severity of injuries, many cases require surgical interventions, lumbosacral spinal fusion or fixation or more complex procedures [5].…”