CRUSH INJURIES TO THE HEAD IN CHILDREN

ALTHOUGH THE MAJORITY of head injuries in children and adults involve dynamic loading conditions, some patients suffer static loading, Stati c loading occurs when forces are applied slowly to the head, and it pr oduces a much different pattern of injuries. Crush injuries are usuall y described in the context of industrial accidents, but in our experie nce, these injuries are not rare in children. We report a series of se ven crush injuries in young children admitted during a period of 29 mo nths and describe our experience in the evaluation and treatment of th is complex entity. Patient ages ranged from 15 months to 6 years. In f our cases, the child's head was run over by a motor vehicle backing up in a driveway or parking lot. In the three other patients, the static loading occurred when the child climbed or pulled on a heavy object, which then fell over with the child and landed on the child's head. On e child with cervicomedullary disruption died shortly after his arriva l at the hospital. The others showed varying degrees of soft tissue in jury to the face and scalp, with Glasgow Coma Scale scores ranging fro m 7 to 15. Computed tomograms and magnetic resonance images showed mul tiple and often extensive comminuted calvarial fractures, as well as s ubarachnoid and parenchymal hemorrhages. All patients had basilar cran ial fractures. There was one cervical spine injury but no major vascul ar injuries. One child had pituitary transection, four had cranial ner ve palsies, and another developed a delayed cerebrospinal fluid rhinor rhea 18 months after injury. All children made good cognitive recoveri es, with some having relatively mild fixed focal deficits. Despite the ir alarming initial history and appearance, children who survive the a cute period of a crush injury to the head have a good long-term progno sis, reflecting the ability of the brain and cranium to withstand quas i-static loading even in the early years of life.