Iatrogenic vertebral body compression fracture in a premature infant caused by extreme flexion during positioning for a lumbar puncture

Abstract

We present a case of vertebral body compression fracture that resulted from manual flexion of the spine of a premature infant in preparation for a lumbar puncture. Vertebral body fractures due to abnormal flexion in child abuse have been described. However, such fractures due to lumbar puncture-related positioning have not been reported. We present a pre-term infant who developed an L3 vertebral body compression fracture immediately after lumbar puncture.

Relating to methodological shortcomings and the concept of temporary brittle bone diseasedoi: 10.1007/s00223-001-0002-9

“…There is no doubt that these types of fractures are seen in physically abused children. However, we believe they can be seen in infants who are not abused, but who have brittle bones from fetal immobilization and/or prematurity from physical forces in the normal handling of the infants [4,5]. Regardless of the type of fracture in an infant with MUF, we believe that a far more helpful piece of information in determining the cause of the fractures would be to know the bone density of that infant.…”

“…Of the infants with long bone fractures, the authors do not provide important details such as developmental history. For example, a spiral fracture of the femur in a non-ambulatory infant is very suggestive of abuse [5].…”

Part 1

“…31 Compression fractures from extreme flexion during an LP can also occur in premature infants and likely result from retropulsion and anterior wedging of vertebral bodies. 13 Osteopenia, often seen in very-low-birthweight infants, increases the likelihood of vertebral injury during procedures such as LP. See Sidebar 1 for clinical tips for gentle and effective immobilization for LP in fragile premature infants.…”

“…9,11,12 Although the diagnosis is primarily considered following a difficult or instrumented delivery, some caregivers may be unaware that SCI can occur in utero, at birth, and in the nursery setting after birth. 13,14 Spinal cord injuries are not always related to trauma and intrapartum events. 2,4,6,15 Conditions that result in cord compression or ischemia have also been implicated.…”

Fracturas torácicas y lumbares en los adolescentes. Estudio de ocho años

“…Puede aparecer de manera aislada o asociado a otro tipo de daño, como a la médula espinal, traumatismo craneal, en extremidades y en otros órganos 2 . Es producido por traumatismos de alta energía, como sucede en los accidentes viales y en las caídas, pero cuando se presentan en niños pequeños se debe sospechar abuso infantil 3,4 . El daño a la columna por proyectil de arma de fuego (PPAF) suele verse en la población militar, presenta un incremento actual en la población civil, debido a la fácil disponibilidad para la obtención de armas de manera no autorizada o ilegal 5,6 .…”