Pediatric chance fractures: A multicenter perspective

Alexandre Arkader, William C. Warner, Vernon T. Tolo, Paul David Sponseller, David L. Skaggs

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Chance fractures or flexion-distraction injuries of the spine are uncommon in children. Previous reports have been limited to isolated case reports or very small retrospective series. This is the largest series reported in the English literature. METHODS: This was a multicenter retrospective review of pediatric Chance fractures treated at 3 large level-1 pediatric trauma centers. We analyzed the demographics, causes, circumstances, treatment, complications, and clinical outcome of 35 patients younger than 18 years old with a Chance fracture. We hypothesize that surgical treatment provides the best results. RESULTS: There were 20 females and 15 males, with an average age of 9 years (range, 1.6 to 17 y). The most common level of injury was at L2 and L3 (20/35). Fifteen children (43%) had a neurological deficit at the time of injury and only 8 fully recovered. One patient deceased before formal orthopaedic treatment. Patients were treated at the discretion of the surgeon and the surgically treated group (20/34) had greater initial kyphotic deformity (22 degrees) than those treated nonoperatively (14/34; 11.4 degrees) and less posttreatment residual kyphotic deformity (3.5 vs. 20 degrees, respectively). The complication rate related to treatment was 26% (9/34) and most complications in the nonoperative group were related to progression of kyphosis whereas in the surgical group most complications are related to discomfort over the hardware (4 patients). Fifteen children (43%) had neurological deficit at presentation, 7 did not fully recover, for an incidence of permanent neurologic deficit of 10% among restrained patients versus 42% for unrestrained patients. Twenty-one patients (62%) had a good final clinical outcome defined by no chronic pain or neurologic deficit, this represented 45% good outcome in the nonoperative group compared with 84% in the operative group (NS). CONCLUSIONS: In this multicenter retrospective study, surgical treatment of Chance fractures in children seems to produce better clinical outcome, the appropriate use of restraints reduce the incidence of definitive neurologic deficit.

Original languageEnglish (US)
Pages (from-to)741-744
Number of pages4
JournalJournal of Pediatric Orthopaedics
Volume31
Issue number7
DOIs
StatePublished - Oct 2011

Fingerprint

Pediatrics
Neurologic Manifestations
Wounds and Injuries
Literature
Therapeutics
Kyphosis
Trauma Centers
Incidence
Chronic Pain
Multicenter Studies
Orthopedics
Spine
Retrospective Studies
Demography

Keywords

  • Chance fracture
  • Lumbar fractures
  • Pediatric Chance
  • Thoraco-lumbar fractures

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Pediatric chance fractures : A multicenter perspective. / Arkader, Alexandre; Warner, William C.; Tolo, Vernon T.; Sponseller, Paul David; Skaggs, David L.

In: Journal of Pediatric Orthopaedics, Vol. 31, No. 7, 10.2011, p. 741-744.

Research output: Contribution to journalArticle

Arkader, Alexandre ; Warner, William C. ; Tolo, Vernon T. ; Sponseller, Paul David ; Skaggs, David L. / Pediatric chance fractures : A multicenter perspective. In: Journal of Pediatric Orthopaedics. 2011 ; Vol. 31, No. 7. pp. 741-744.
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N2 - BACKGROUND: Chance fractures or flexion-distraction injuries of the spine are uncommon in children. Previous reports have been limited to isolated case reports or very small retrospective series. This is the largest series reported in the English literature. METHODS: This was a multicenter retrospective review of pediatric Chance fractures treated at 3 large level-1 pediatric trauma centers. We analyzed the demographics, causes, circumstances, treatment, complications, and clinical outcome of 35 patients younger than 18 years old with a Chance fracture. We hypothesize that surgical treatment provides the best results. RESULTS: There were 20 females and 15 males, with an average age of 9 years (range, 1.6 to 17 y). The most common level of injury was at L2 and L3 (20/35). Fifteen children (43%) had a neurological deficit at the time of injury and only 8 fully recovered. One patient deceased before formal orthopaedic treatment. Patients were treated at the discretion of the surgeon and the surgically treated group (20/34) had greater initial kyphotic deformity (22 degrees) than those treated nonoperatively (14/34; 11.4 degrees) and less posttreatment residual kyphotic deformity (3.5 vs. 20 degrees, respectively). The complication rate related to treatment was 26% (9/34) and most complications in the nonoperative group were related to progression of kyphosis whereas in the surgical group most complications are related to discomfort over the hardware (4 patients). Fifteen children (43%) had neurological deficit at presentation, 7 did not fully recover, for an incidence of permanent neurologic deficit of 10% among restrained patients versus 42% for unrestrained patients. Twenty-one patients (62%) had a good final clinical outcome defined by no chronic pain or neurologic deficit, this represented 45% good outcome in the nonoperative group compared with 84% in the operative group (NS). CONCLUSIONS: In this multicenter retrospective study, surgical treatment of Chance fractures in children seems to produce better clinical outcome, the appropriate use of restraints reduce the incidence of definitive neurologic deficit.

AB - BACKGROUND: Chance fractures or flexion-distraction injuries of the spine are uncommon in children. Previous reports have been limited to isolated case reports or very small retrospective series. This is the largest series reported in the English literature. METHODS: This was a multicenter retrospective review of pediatric Chance fractures treated at 3 large level-1 pediatric trauma centers. We analyzed the demographics, causes, circumstances, treatment, complications, and clinical outcome of 35 patients younger than 18 years old with a Chance fracture. We hypothesize that surgical treatment provides the best results. RESULTS: There were 20 females and 15 males, with an average age of 9 years (range, 1.6 to 17 y). The most common level of injury was at L2 and L3 (20/35). Fifteen children (43%) had a neurological deficit at the time of injury and only 8 fully recovered. One patient deceased before formal orthopaedic treatment. Patients were treated at the discretion of the surgeon and the surgically treated group (20/34) had greater initial kyphotic deformity (22 degrees) than those treated nonoperatively (14/34; 11.4 degrees) and less posttreatment residual kyphotic deformity (3.5 vs. 20 degrees, respectively). The complication rate related to treatment was 26% (9/34) and most complications in the nonoperative group were related to progression of kyphosis whereas in the surgical group most complications are related to discomfort over the hardware (4 patients). Fifteen children (43%) had neurological deficit at presentation, 7 did not fully recover, for an incidence of permanent neurologic deficit of 10% among restrained patients versus 42% for unrestrained patients. Twenty-one patients (62%) had a good final clinical outcome defined by no chronic pain or neurologic deficit, this represented 45% good outcome in the nonoperative group compared with 84% in the operative group (NS). CONCLUSIONS: In this multicenter retrospective study, surgical treatment of Chance fractures in children seems to produce better clinical outcome, the appropriate use of restraints reduce the incidence of definitive neurologic deficit.

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