title: Surgical management of severely displaced pediatric seat-belt fracture-dislocations of the lumbar spine associated with occlusion of the abdominal aorta and avulsion of the cauda equina: a report of two cases.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To present 2 cases of fracture-dislocations of the lumbar spine associated with injury to the aorta and avulsion of the cauda equina and present recommendations regarding urgent management of these injuries.
  
  
  BACKGROUND
  The "seat-belt syndrome" was first described by Garrett and Braunstein in 1962 to describe intraabdominal visceral injuries with fractures of the lumbar spine. Although this syndrome has been described in previously, there have been no reported cases of pediatric patients with significant injury to the abdominal aorta.
  
  
  METHODS
  We present 2 seat-belt injuries occurring within a 4 month period at a pediatric trauma center with significantly displaced lumbar fracture-dislocation, abdominal aortic occlusion, and complete neurologic injury.
  
  
  RESULTS
  Rigid fixation of the spinal fracture dislocation in both cases was delayed since these patients were deemed to be hemodynamically unstable. Aggressive mobilization, wound care, and pulmonary toilet were possible after stabilization of the spine. Despite this, 1 patient eventually died.
  
  
  CONCLUSIONS
  These cases need to be managed according to principles established in the treatment of extremity fractures with vascular and neurologic injuries. That is, early rigid fixation of the fracture to protect the vascular repair.
authors.affiliation: University of Louisville Department of Orthopaedic Surgery, Louisville, KY, USA.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Crawford
authors.forename: Rolando M
authors.initials: RM
authors.lastname: Puno
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Campbell
authors.forename: Leah Y
authors.initials: LY
authors.lastname: Carreon
mesh_terms: D000063:Accidents, Traffic; D001012:Aorta, Abdominal / Q000293:injuries* / Q000601:surgery; D001018:Aortic Diseases / Q000209:etiology* / Q000601:surgery; D001157:Arterial Occlusive Diseases / Q000209:etiology* / Q000601:surgery; D002420:Cauda Equina / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D017809:Fatal Outcome; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D011843:Radiculopathy / Q000209:etiology* / Q000601:surgery; D011859:Radiography; D012622:Seat Belts / Q000009:adverse effects*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013577:Syndrome; D017131:Thrombectomy; D016896:Treatment Outcome