PEDIATRIC SEAT-BELT INJURIES - DIAGNOSIS AND TREATMENT OF LUMBAR FLEXION-DISTRACTION INJURIES

Motor vehicle accidents are the major cause of flexion-distraction inj uries of the thoracolumbar spine. In a retrospective review, we presen t the results of operative treatment for six pediatric patients who su stained such injuries while wearing seatbelts. There were three purely ligamentous injuries, two bony injuries (Chance fractures), and one c ombination injury. There were also concomitant neurological and intra- abdominal injuries. Of note is that two patients had either their spin al or abdominal injury missed on initial evaluation. All patients were treated surgically with open reduction and internal fixation. At aver age follow up of 2 years, all patients had a full range of motion with no back pain. Five had returned to their preinjury activity levels, w hile the sixth patient was paraplegic from his injury but was able to ambulate at home with crutches and knee-ankle-foot orthoses. We recomm end operative reduction and two-level fusion of these injuries when (1 ) instability is apparent in either a purely ligamentous injury or an overtly unstable fracture-pattern, (2) significant kyphosis is present which cannot be reduced or maintained in a cast, or (3) there is asso ciated neurological or intra-abdominal injury.