Chance fracture--a rare injury in pediatric patients?
We report on a 9-year-old girl who was involved in a car accident. She suffered severe polytrauma with torn abdominal muscles, rupture of the mesenteric arteries, bowel and bladder, hematoma at the right colonic flexure and disruption of the intervertebral ligaments L2/L3, including the intervertebral disc, typical of Chance fracture. The abdominal bleeding was stopped, the bowel resected and the fracture fixed by internal fixation. The patient developed a postoperative enterocutaneous fistula in the right flank and paraplegia. She underwent three laparotomies with ileostomy and closure of the fistula. Two years later, she has normal bowel movement, the wounds are closed, the internal fixation has been removed, she is able to walk with crutches and suffers from a mild bladder dysfunction. Chance fracture is a typical fracture in adults involved in motor vehicle accidents. In the last 10 years, there have only been four case reports describing this fracture in children under the age of 10. All of these individuals were involved in a car accident and had been fixed with a lap belt. With the increasing use of lap belts, this fracture has to be considered even in young children. Mild clinical symptoms can be associated with severe intra-abdominal injuries.
Subotic
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Department of Pediatric Surgery, University of Berne, Switzerland. ulrike.subotic@insel.ch
Holland-Cunz
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Bardenheuer
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Loff
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Wessel
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D000007:Abdominal Injuries / Q000175:diagnosis / Q000601:surgery*; D000063:Accidents, Traffic; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007403:Intervertebral Disc / Q000293:injuries*; D007813:Laparotomy / Q000379:methods*; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D009104:Multiple Trauma; D016103:Spinal Fractures / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices