Pediatric seatbelt injuries: diagnosis and treatment of lumbar flexion-distraction injuries.

Motor vehicle accidents are the major cause of flexion-distraction injuries of the thoracolumbar spine. In a retrospective review, we present the results of operative treatment for six pediatric patients who sustained such injuries while wearing seatbelts. There were three purely ligamentous injuries, two bony injuries (Chance fractures), and one combination injury. There were also concomitant neurological and intra-abdominal injuries. Of note is that two patients had either their spinal or abdominal injury missed on initial evaluation. All patients were treated surgically with open reduction and internal fixation. At average follow up of 2 years, all patients had a full range of motion with no back pain. Five had returned to their preinjury activity levels, while the sixth patient was paraplegic from his injury but was able to ambulate at home with crutches and knee-ankle-foot orthoses. We recommend operative reduction and two-level fusion of these injuries when (1) instability is apparent in either a purely ligamentous injury or an overtly unstable fracture-pattern, (2) significant kyphosis is present which cannot be reduced or maintained in a cast, or (3) there is associated neurological or intra-abdominal injury.

Chronologic outcome of surgical tendoachilles lengthening and natural history of gastroc-soleus contracture in cerebral palsy. A two-part study.

Medical records of 59 patients with cerebral palsy were reviewed retrospectively to evaluate results of tendoachilles lengthening. Surgical lengthening resulted in highly significant (p < 0.0001) initial average gains in dorsiflexion compared with baseline. These average improvements maintained their statistical significance for seven years postoperatively. The arc of motion was not significantly different postoperatively. The initial ambulatory level was improved in 55% of the patients and maintained in the remainder. However, 14 ankles (11.9%) in eight patients (13.6%) required repeat tendoachilles lengthening during the study period, primarily after gastrocnemius procedures. Calcaneus deformity occurred in 1.7% of the surgically treated ankles. To evaluate the potential for spontaneous improvement over time in fixed equinus deformity, the records of a group of 68 additional cerebral palsy patients were reviewed. Patients treated nonoperatively despite two examinations that demonstrated fixed lack of dorsiflexion, while not representing a true control group, showed no spontaneous improvement in equinus deformity through seven years postoperatively.

Results of Harrington instrumentation in type A and type B burst fractures.

Comparisons of the reductions achieved with posterior Harrington instrumentation of 21 type A and 26 type B burst fractures revealed that the percent correction of angular deformity at surgery was significantly higher (type A, 52% versus type B, 65%) and was better maintained at 6 (type A, 13% versus type B, 36%) and 12 months (type A, 0% versus type B, 28%) after surgery in type B fractures (p less than 0.05). Percent correction of anterior compression achieved at surgery was similar for both groups (type A, 33% versus type B, 37%), but maintenance of correction 6 (type A, 9% versus type B, 23%) and 12 months after surgery (type A, 3% versus type B, 23%) also was significantly better in type B fractures (p less than 0.05). Percent correction of sagittal plane displacement immediately following surgery (type A, 71% versus type B, 73%), and 6 (type A, 62% versus type B, 61%) and 12 months after surgery (type A, 60% versus type B, 56%) was the same in both groups. Results of posterior instrumentation of burst fractures appears to be dependent upon the type of burst injury; significantly better reductions were achieved and maintained in Denis type B fractures.