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Lumbar compression fractures secondary to lap-belt use in children
P F Sturm1, R B Glass, C J Sivit
1Department of Orthopaedic Surgery, Children's National Medical Center, Washington, DC 20010, USA.
Insights
Lap belts can cause lumbar spine compression fractures in children, unlike typical flexion-distraction injuries. This is likely due to children
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Biomechanics
Background:
- Flexion-distraction injuries are commonly associated with lap-belt use.
- Children possess increased elasticity in their posterior ligamentous complex.
- This elasticity may predispose them to unique injury patterns.
Purpose of the Study:
- To investigate the occurrence of lumbar spine compression fractures in children due to lap-belt use.
- To explore the potential mechanism of injury in these cases.
- To compare these injuries with typical flexion-distraction injuries.
Main Methods:
- Retrospective review of pediatric trauma cases over a 10-year period.
- Identification of children with lumbar spine compression fractures linked to lap-belt use.
- Analysis of patient demographics, seating position, and associated injuries.
Main Results:
- Seven children were identified with lumbar spine compression fractures from lap-belt use.
- The average age was 7 years; 57% had associated abdominal injuries.
- Four children were rear-seat passengers, and three were front-seat passengers.
Conclusions:
- Children can sustain lumbar spine compression fractures from lap-belt use.
- The mechanism may differ from typical adult flexion-distraction injuries.
- Increased spinal elasticity in children could contribute to this injury pattern.
Abstract:
The correlation between flexion-distraction injuries and lap-belt use has been well documented. Over a 10-year period, we identified seven children admitted to Children's National Medical Center, Washington, DC, with compression fractures of the lumbar spine secondary to lap-belt use. Four were rear seat passengers, and three were in the front seat. The average age was 7 years. Four of the seven (57%) suffered associated abdominal injuries. One died of an associated head injury. We hypothesize that the mechanism of injury in these cases was similar to that in flexion-distraction injuries. The increased elasticity in the posterior ligamentous complex in children may be responsible for the occurrence of these compression fractures rather than the expected flexion-distraction-type injuries.