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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.
Insights
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.
Abstract:
Previous description of cervical spine fractures in children have emphasized high mortality injuries to the upper cervical vertebra. Our experience suggests a much wider spectrum of injury. The medical records of all children with cervical spine fractures admitted to Children's Hospital between January 1, 1985 and December 31, 1989 were reviewed. The average age of the 50 patients was 11 years (range, 2.7 to 18.8 years) and 62% were boys. Motor vehicle-related accidents (54%), sports injuries (18%), and falls (12%) accounted for the majority of the fractures. Twenty-nine patients (58%) had an associated head injury. Fifty percent of the patients were transported from the accident scene and 44% were interhospital transfers. All patients receiving medical care prior to referral had appropriate cervical spine stabilization. On admission 30% of the patients were unresponsive. Thirty-one children were alert and verbal at the time of evaluation and 30 complained of neck pain and tenderness (97%). Twenty-five of the 31 patients (83%) had no demonstrable neurological deficit on initial physical examination. Lateral cervical spine radiographs were diagnostic in 49 children (98%). A relatively even distribution of fractures occurred at all levels of the cervical spine. The anatomic site of the injury did not correlate with age. Sixteen patients (32%) died. Of the 34 who survived, only 6 had a persistent neurological deficit. Children with cervical spine fractures have two distinct patterns of presentation: lethal or intact. The majority of children with cervical spine fractures presented with no complaints of neck pain and/or tenderness need a complete radiographic evaluation of their cervical spine.