Open reduction and internal fixation of a lumbar Chance fracture in a child using Songer cable and lamina plates

Abstract

<jats:p>Chance-type fractures of the spine have been associated with seat-belt injuries in the pediatric population. Nonoperative management is appropriate in most cases of Chance fractures, but surgical intervention is occasionally warranted to deter progression of kyphosis and neurological deterioration. Internal fixation using pedicle screws has been widely used in the surgical repair of this injury. The authors report on a 6-year-old girl who suffered an L-2 Chance fracture with facet disruption, kyphosis, and significant posterior ligamentous injury. She underwent open reduction and internal fixation using Songer cable wiring augmented with bilateral lamina plating. At the 18-week follow-up, she continued to be free of any neurological deficits and her alignment was stable on plain radiographs of flexion-extension. The authors have therefore described a feasible option in the surgical management of Chance-type fractures in the pediatric spine.</jats:p>

Temporary Percutaneous Pedicle Screw Fixation for Treatment of Thoracolumbar Injuries in Young Adults

“…They instead had to rely on a combination of wiring and plating. 19 Still, this is a rare case. In the majority of young adult patients with thoracolumbar trauma, safe insertion of pedicle screw fixation is possible.…”

Flexion-distraction Injuries in Children and Adolescents

“…Of these studies, 1 had a sample size greater than 20 patients, 7 four had between 10 and 20 patients, 4,[8][9][10] five had between 4 and 9 patients, 1,5,11-13 and 15 were case series or case reports with 3 or fewer patients. 3,[14][15][16][17][18][19][20][21][22][23][24][25][26][27] Demographic Data. Patient age was available for 115 patients in these studies and ranged from 2 to 17 years.…”

“…cme ARTICLE Neurologic Injuries. Rates of neurologic injury varied widely across the literature, with some reporting a 0% rate of neurologic injury 8,9,[13][14][15][16][17]19,21,[25][26][27] and others reporting paraplegia rates as high as 30%. 4 The largest series available reported spinal cord injury resulting in paraplegia in 2 (7.7%) of 28 patients and nerve root injuries in 4 (14.3%) patients.…”

“…The majority of patients were treated with extension casting. Patients managed surgically were treated with instrumented posterior spinal fusions using a variety of implants, including pedicle screws, Harrington rods, 11,12 Cotrel-Debousset instrumentation, 20 lamina plates and cables, 14 spinous process wiring, 11,15 sublaminar wires, 11 and sublaminar fixation using polyethylene tape. 26 Only 1 study attempted to provide guidelines for injury treatment.…”

Chance Fracture in Three Brothers

“…Thoracic-lumbar fracture caused by flexion-distraction mechanism is regarded as rather uncommon in the pediatric population 1,16,20 . Actually, these injuries were virtually unknown before the widespread use of lap seat belts as a mean of restraint and were first formally described in 1948 by Chance, 2,21 .…”