[Treatment and prognosis in vertebral fractures in children and adolescents]

Twenty-six children and adolescents with a total of 65 vertebral fractures are reported. Sixteen patients could be followed up an average of 3 1/4 years after the accident. The questions of growth disturbance after vertebral body fractures and adequate treatment are chiefly considered. -Most of the fractures occurred in the midthoracic spine. As a rule they were serial fractures. -Fractures of the vertebral body with sagittal wedge deformity alone have a better prognosis than those with concomitant sagittal and frontal wedge deformities. Whereas those in the first group correct themselves partially or completely during subsequent growth, improvement in the wedge deformity was only observed in about one-third of the patients in the second group. When the end-plates were fractured, there was no correction and there was a lack in vertebral growth. Severe destruction of the cartilagenous plates and intervertebral discs led to a fusion of the corresponding segment. Increase in wedge deformity was observed twice. -Slight axial deviations of the intervertebral discs following vertebral body fractures are compensated for during growth in most cases. In comminuted fractures, the axial deviation persists but can be compensated for by the adjacent segments of the spine. In instable fractures, it can increase in spite of treatment in a Milwaukee corset. -No difference was found between the children treated with a hyperextension plaster corset and those treated functionally. On the basis of the results, the fracture types which should be treated functionally and those for which a plaster cast is recommended are indicated.