Abdominal Injuries Associated With Paediatric Flexion-Distraction Fractures Of The Lumbar Spine

Abstract

ABDOMINAL INJURIES ASSOCIATED WITH PAEDIATRIC FLEXION-DISTRACTION FRACTURES OF THE LUMBAR SPINE

Brian Martin, Robert Labrom, Jason Harvey, Maree Izatt, Stephen Tredwell, Geoff Askin

Paediatric Spine Research Group, Queensland University of Technology and Mater Health Services, Brisbane, Australia.

Introduction
The goals of this study were to investigate the association between paediatric flexion-distraction fractures of the lumbar spine and abdominal injuries and to analyse the variety of the abdominal injuries seen with this type of fracture.

Methods
A retrospective chart review was performed at three hospitals (British Columbia Children’s Hospital Vancouver Canada, Mater Children’s Hospital and Royal Children’s Hospital, Brisbane). All patients under the age of fifteen who had suffered a flexion-distraction fracture were included. Data collected from the chart related to seating position, the use of seat belts and the spinal and abdominal injuries. The time elapsed from presentation to the time of diagnosis of abdominal injury was also recorded.

Results
Forty one patients were included. There were 16 male and 25 female patients. All injuries were due to motor vehicle accidents. The average age at the time of accident was 9 years and 8 months. Twenty two of the forty one patients (53%) suffered an intra-abdominal injury. Twenty one of these patients required operative intervention for their abdominal trauma. The spectrum of injuries included small bowel, large bowel, mesenteric and solid organ injuries. Eighteen of the twenty two patients sustained a small bowel injury.

Discussion
Abdominal trauma after flexion-distraction fractures of the lumbar spine are common. Often the abdominal trauma is significant and may require a laparotomy. A high index of suspicion should be maintained for all patients who present to the orthopaedic department with this type of injury.