Study Design. A case report of a 9-year-old boy treated at a pediatric trau
ma center for a flexion-extension spiral fracture with late development of
an enterocolic fistula subsequent to a high-velocity motor vehicle accident
.
Objectives. To increase the awareness of possible delayed bowel complicatio
ns associated with flexion-distraction injuries of the spine in children.
Summary of Background Data. Flexion-distraction fractures of the spine in c
hildren wearing lap seat belts, so-called "Chance" fractures, are an increa
singly common result of high-velocity collisions. This type of fracture, re
ferred to as a seat-belt fracture, is often associated with duodenal or jej
unal tears. Although such intra-abdominal injuries are common in such fract
ures secondary to this type of trauma, the occurrence of an enterocolic fis
tula has never been reported.
Methods. A review of all pediatric Chance fractures managed at the Children
's Hospital of Eastern Ontario, as well as a literature review of all repor
ted series of flexion-distraction injuries to the spine in children, were p
erformed.
Results. The subtle and prolonged symptomatology of this lesion and its sim
ilarity to a cast syndrome is emphasized.
Conclusion. Because the orthopedic surgeon is usually the primary care-give
r for children with this type of seat; belt trauma, an appreciation of the
possibility of a delayed onset enterocolic fistula-with its symptomatology
is essential to avoid prolonged morbidity.