Abdominal injuries associated with thoraco-lumbar fractures after motor vehicle collision

Purpose: The goal of the current study was to evaluate the risk of intraabd ominaI injury in children who sustained spinal fractures in a motor vehicle collision (MVC). Methods: Between 1980 and 1999, 48 patients, 24 girls and 24 boys, with a m ean age of 12.8 years (range, 4 to 17) were reviewed. Twenty-nine were rear seat passengers, 12 front seat, and 7 unknown. Fifty-eight percent wore a seat belt. Thirty fractures involved the lumbar spine, 12 the thoracic, and 6 combined. Computed tomography (CT) scan, abdominal ultrasound, and perit oneal lavage were used to screen for abdominal injuries. Results: Twenty-two of 48 patients had an intraabdominal injury. Eighteen ( 38%) required an early (<24 hours; n = 12) or delayed (n = 6) therapeutic l aparotomy. Fourteen patients were rear seat passengers, 15 wore a seat belt , and 13 had an abdominal wall ecchymoses (AWE). They were 17 lumbar fractu res (13 Chance) and one thoracic. The most common findings at laparotomy we re hollow viscus injury (n = 12), mesenteric tear (n = 9), and solid organ injury (n = 8). Seventy-two percent of patients presenting with a lumbar fr acture and AWE needed a therapeutic laparotomy. The overall survival rate w as 98% with only 1 death. The mean hospital stay was 22.4 days. In this stu dy, 38% of patients presenting with a spinal fracture required laparotomy, 68% of whom had simultaneous lumbar fracture and AWE. Conclusion: in light of these results, the authors propose that laparoscopy or laparotomy should be strongly considered in patients sustaining lumbar fracture and AWE after MVC. J Pediatr Surg 36:760-762. Copyright (C) 2001 b y W.B. Saunders Company.