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Pediatric nonaccidental trauma thoracolumbar fracture-dislocation: posterior spinal fusion with pedicle screw fixation in an 8-month-old boy.

Bode KS, Newton PO

Department of Orthopaedics, Wilford Hall Medical Center, San Antonio, TX, USA. Kenneth.bode@lackland.af.mil

STUDY DESIGN: Case report of pedicle screw fixation in an infant with nonaccidental spine trauma. OBJECTIVE: To ensure awareness of nonaccidental pediatric spine trauma and describe a safe and effective method of treating a complex problem of thoracolumbar fracture-dislocation in an infant. SUMMARY OF BACKGROUND DATA: Nonaccidental pediatric spine trauma is rare, accounting for <1% of abuse. No previous cases of pedicle screw fixation have been described in a patient younger than 1 year of age. Prior treatment of this clinical entity has been treated with casts or wire-fixation. METHODS: An 8-month-old boy had a nonaccidental (also known as child abuse) traumatic T12-L1 fracture-dislocation. This was subsequently surgically corrected with posterior spinal fusion and instrumentation with pedicle screws. RESULTS: After surgery, the patient is doing well with no adverse effects from surgery. CONCLUSIONS: Although child abuse is a rare cause of spinal trauma, clinicians should do a full skeletal survey to ensure no other injuries are overlooked. Pedicle screw fixation can be used in infants with unstable traumatic spinal injuries, allowing earlier rehabilitation and return to normal activity level.

Published 18 June 2007 in Spine, 32(14): E388-93.
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