title: Seat belt fracture with late development of an enterocolic fistula in a child. A case report.
abstract: METHODS
  A case report of a 9-year-old boy treated at a pediatric trauma center for a flexion-extension spiral fracture with late development of an enterocolic fistula subsequent to a high-velocity motor vehicle accident.
  
  
  OBJECTIVE
  To increase the awareness of possible delayed bowel complications associated with flexion-distraction injuries of the spine in children.
  
  
  BACKGROUND
  Flexion-distraction fractures of the spine in children wearing lap seat belts, so-called "Chance" fractures, are an increasingly common result of high-velocity collisions. This type of fracture, referred to as a seat-belt fracture, is often associated with duodenal or jejunal tears. Although such intra-abdominal injuries are common in such fractures secondary to this type of trauma, the occurrence of an enterocolic fistula has never been reported.
  
  
  METHODS
  A review of all pediatric Chance fractures managed at the Children's Hospital of Eastern Ontario, as well as a literature review of all reported series of flexion-distraction injuries to the spine in children, were performed.
  
  
  RESULTS
  The subtle and prolonged symptomatology of this lesion and its similarity to a cast syndrome is emphasized.
  
  
  CONCLUSIONS
  Because the orthopedic surgeon is usually the primary care-giver for children with this type of seat-belt trauma, an appreciation of the possibility of a delayed onset enterocolic fistula with its symptomatology is essential to avoid prolonged morbidity.
authors.affiliation: Division of Pediatric Orthopaedics, Children's Hospital of Eastern Ontario, University of Ottawa, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Letts
authors.forename: D
authors.initials: D
authors.lastname: Davidson
authors.forename: P
authors.initials: P
authors.lastname: Fleuriau-Chateau
authors.forename: S
authors.initials: S
authors.lastname: Chou
mesh_terms: D000063:Accidents, Traffic; D002370:Casts, Surgical / Q000009:adverse effects; D002648:Child; D003937:Diagnosis, Differential; D006801:Humans; D007412:Intestinal Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D007421:Intestine, Small / Q000293:injuries; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D008297:Male; D012622:Seat Belts / Q000009:adverse effects*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D014057:Tomography, X-Ray Computed