Seat-belt injuries of the spine in young children

Abstract

Seat-belt fractures of the lumbar spine in adolescents and adults are well recognised but there are few reports of these injuries in young children. We reviewed all seat-belt injuries in skeletally immature patients (Risser 0), seen at a tertiary referral centre between 1974 and 1991. There were ten cases, eight girls and two boys, with an average age of 7.5 years (3 to 13). Four distinct patterns of injury were observed, most commonly at the L2 to L4 level. Paraplegia, which is thought to be uncommon, occurred in three of our ten cases. Four children had intra-abdominal injuries requiring laparotomy. There was a delay in diagnosis either of the spinal or of the intra-abdominal injury in five cases, although all had contusion of the abdominal wall, the 'seat-belt sign'. Treatment of the fractures was conservative, by bed rest and then hyperextension casts. The incidence of this potentially devastating injury can be reduced by the optimal use of restraints, but there is often a delay in diagnosis. Our classification system may aid in the early detection and evaluation of this injury.

Outcome Analysis of Chance Fractures of the Skeletally Immature Spine

“…It has been proposed that there is an increased risk of seat belt syndrome using 2-point restraint as the lap belt alone offers no restraint of the torso or head and during sudden deceleration the lap belt serves as a fulcrum around which the spine hyperflexes. 5,13,15 However, 40% of the patients in our series were restrained by a combined lap and shoulder belt. The type of seat belt worn during the time of the accident was established from the patient's medical records, ambulance notes, and parent interviews.…”

“…4,5,9,[13][14][15][16] The term "seat belt sign" describes the abrasions, contusions, and abdominal wall ecchymoses that is typical of restrained passengers. In pediatric patients with seat belt sign, there is a 78% rate of intraabdominal injuries; and in 21% of patients, there is a concurrent flexion distraction fracture of the lumbar spine.…”

“…Inadequate development of the iliac crests precludes proper lap belt placement over the adult anchor points resulting in the belt riding up over the abdomen and creating an anterior fulcrum point for a hyperflexion injury. 15,18 As well, the bony pelvis and thoracic cage of a child offer less protection for the intraabdominal organs. 19 In our series, the mean age of L1 fractures was higher compared with L2 and L3; we are cautious in drawing any significance to this because of the small number of patients in this series.…”

Classification of Chance Fracture in Children Using Magnetic Resonance Imaging

“…In the Rumball and Jarvis classification, 10 Types A and C described bony lesions alone corresponding to our Type II fracture. Type B corresponds to an avulsion of the posterior elements with facet joint disruption or fracture and extension into the superior apophysis of the vertebral body.…”

Case Study: Correlation between the Seat Belt Sign and Positive Abdominal Computed Tomography Findings in Pediatric Trauma Patients∗

“…The presence of a seat belt sign has long been associated with a high index of suspicion for BII in the MVC victim (Shamblin, 1968). Rumball and Jarvis (1992) noted that children are susceptible to seat belt injuries anatomically because of a relatively higher center of gravity and lack of development of the iliac crests and the abdominal musculature. Tso et al (1993)also noted that children tend to allow the seat belt to ride cephalad around the level of the umbilicus instead of over the iliac crests.…”