Related Experiment Video
Updated: Nov 28, 2025
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Clival fractures in children: a challenge in the trauma room setting!
Julian Fromm1, Eliane Meuwly2, Danielle Wendling-Keim1
1Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Lindwurmstr. 4, 80337, Munich, Germany.
Insights
Pediatric clival fractures are rare, life-threatening injuries. Early diagnosis and imaging are crucial due to high rates of vascular damage and mortality in children.
Area of Science:
- Pediatric Traumatology
- Neurotrauma
- Skull Base Fractures
Background:
- Clival fractures are rare but severe traumatic brain injuries in children.
- Limited literature exists on pediatric clival fracture diagnosis and treatment.
Purpose of the Study:
- To review the diagnosis, classification, and clinical course of pediatric clival fractures.
- To highlight the importance of early vascular injury assessment.
Main Methods:
- Case reports of two pediatric patients with clival fractures.
- Systematic literature review of 37 pediatric cases (age 1-18).
Main Results:
- Mortality rate of 23% in pediatric clival fractures.
- Over 50% experienced cranial nerve damage.
- Two-thirds had intracranial vascular damage or bleeding.
Conclusions:
- Pediatric clival fractures are challenging to diagnose, especially with unfused sphenooccipital synchondrosis.
- Vascular damage is common; contrast-enhanced CT or MRA is recommended for prompt evaluation.
Objective:
A clival fracture is a rare but life-threatening traumatic brain injury in the adult and pediatric populations. To date, there are very few conclusive recommendations in the literature concerning the diagnosis and treatment of pediatric clival fractures.
Methods:
In 2014 and 2015, two pediatric patients with severe blunt head trauma and clival fractures were evaluated and treated at a level I trauma center. Both cases are documented and supplemented by an extensive review of the literature focusing on the diagnostic workup, classification, and clinical course of clival fractures in children.
Results:
The clinical course of two children (8 and 9 years old) with clival fractures in concert with other intra- and extracranial injuries was analyzed. A total of 17 papers encompassing 37 patients (age range, 1-18 years) were included for a systematic review. The literature review revealed a mortality rate of 23% in pediatric patients with a clival fracture. Over 50% of the patients presented with cranial nerve damage, and two-thirds suffered from intracranial vascular damage or intracerebral bleeding.
Conclusions:
Clival fractures are a very rare but severe consequence of blunt head trauma in the pediatric population and may be challenging to diagnose, especially in cases with an unfused sphenooccipital synchondrosis. Vascular damage following clival fractures appears to be as common in pediatric patients as in adults. Therefore, contrast-enhanced CT of the cervical spine and head and/or magnetic resonance angiography is strongly recommended to rule out vascular injury of the extra- and intracranial brain-supplying vessels within the trauma room setting.
Related Concept Videos
01:26Flail Chest-II
Assessment:
1. Clinical Evaluation:
History:
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
01:24Flail Chest-I
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...