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Pediatric cervical spine fractures: predominantly subtle presentation.
A M Dietrich1, M E Ginn-Pease, H M Bartkowski
1Division of Emergency Medicine, Ohio State University College of Medicine, Columbus.
Journal of Pediatric Surgery
|August 1, 1991
Summary
Pediatric cervical spine fractures present a broad spectrum of injuries, not just severe upper neck trauma. Many children with these fractures have no neck pain but still require thorough radiographic evaluation.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Radiology
Background:
- Cervical spine fractures in children were previously thought to be primarily high-mortality upper cervical injuries.
- This study investigates a wider spectrum of pediatric cervical spine fractures.
Purpose of the Study:
- To describe the clinical presentation, injury patterns, and outcomes of pediatric cervical spine fractures.
- To identify distinct patterns of presentation in children with cervical spine fractures.
Main Methods:
- Retrospective review of medical records for 50 pediatric patients with cervical spine fractures (1985-1989).
- Analysis of patient demographics, injury mechanisms, associated injuries, clinical findings, diagnostic imaging, and outcomes.
- Correlation of fracture location with age and neurological deficits.
Main Results:
- The average age was 11 years, with motor vehicle accidents being the most common cause (54%).
- 58% had associated head injuries; 30% were unresponsive on admission.
- Lateral cervical spine radiographs were diagnostic in 98% of cases. Fractures occurred at all levels.
- Mortality was 32%, with most survivors having no persistent neurological deficit.
Conclusions:
- Pediatric cervical spine fractures exhibit two distinct patterns: lethal or intact.
- A significant proportion of children with cervical spine fractures present without neck pain or tenderness.
- Complete radiographic evaluation is crucial for all children with suspected cervical spine fractures, regardless of symptoms.