Child Abuse with Thoracolumbar Fracture-Dislocation Treated with Pedicle Screw Fixation in a 2-Year-Old

Abstract

Case: A nonverbal 2-year-old boy presented with acute-on-chronic thoracolumbar fracture-subluxation with associated chylothorax and progressive neurologic dysfunction secondary to nonaccidental trauma. We discussed the successful management of this patient with short-segment pedicle screw instrumentation resulting in complete resolution of his chylothoraxes and neurologic impairment. A clinical follow-up is reported out to 12 months after hardware removal. Conclusion: Thoracolumbar fracture-subluxation with massive chylothorax is a rare and important presentation of nonaccidental trauma that must be recognized. Temporary pedicle screw fixation is a successful treatment option for young children presenting with this difficult spinal pathology.

Thoracolumbar fracture-dislocation in a two-year-old female child following child abuse: A case report and literature review

“… Webb et al [ 17 ] 2020 1 29 months Fracture of the fourth lumbar (l4) vertebral body NA Child abuse NA Dead approximately two hours after arrival NA 11. Thornley et al [ 7 ] 2021 1 2 years Acute-on-chronic thoracolumbar fracture-subluxation Progressive neurologic dysfunction Child abuse Short-segment pedicle screw instrumentation 12 months Complete resolution of neurologic impairment …”

“…In our case, a 2-year-old child suffered a fracture dislocation at the T12-L1 level from child abuse. Thornley P et al [ 7 ] reported a case of a 2-year-old boy child who suffered from thoracolumbar fracture-subluxation. They advocated their case as the first reported case of complete treatment, along with the consequent removal of hardware for a pediatric thoracolumbar fracture-subluxation.…”

“…In our case, treatment consisted of surgical intervention, followed by sublaminar wiring. Thornley P et al [ 7 ] reported a follow-up of one year, and revealed that the patient was neurologically stable with complete power and symmetrical sensation throughout the L2-S1 distribution. In our case, we did an 18-month follow-up and our patient displayed excellent clinical and radiographic results with good neurological improvement.…”

“…In patients aged less than two years old, a significant mechanism of injury is non-accidental trauma (NAT), with around 38 % of pediatric patients being abused [ 7 ]. To date, there are only a few cases being reported with thoracolumbar fractures affecting infants and toddlers.…”

Trauma no accidental de columna toracolumbar en un niño de 10 meses

“…Se han publicado unos 50 casos de fracturas toracolumbares pediátricas, el 38% de ellas atribuidas a LNA en menores de dos años. 6,7 Lamentablemente, la omisión o el diagnóstico tardío afectan a más de un tercio de las víctimas. En este sentido, se han comunicado fracturas de huesos largos en un 77% y traumatismo craneoencefálico en el 50% de los casos.…”