title: Pediatric crushing head injury: biomechanics and clinical features of an uncommon type of craniocerebral trauma.
abstract: BACKGROUND
  Head injuries constitute one of the leading causes of pediatric morbidity and mortality. Most injuries result from accidents involving an acceleration/deceleration mechanism. However, a special type of head injury occurs when the children sustain a traumatism whose main component is a static load in relation to a crushing mechanism with the head relatively immobile.
  
  
  METHODS
  We report a series of children who sustained a craniocerebral injury of variable severity produced by head crushing. We also analyze epidemiological and clinical data, and biomechanics in these injuries.
  
  
  RESULTS
  Mean age of the group (13 boys/6 girls) was 4.1 years. All patients showed external lesions (scalp wounds or hemorrhage from the nose, ears, or throat). Eleven children were initially unconscious. Six children presented cranial nerve deficits in addition to impaired hearing. Skull base fractures were seen in most cases with extension to the vault in 11 instances. Fourteen patients had an associated intracranial lesion, including two with diffuse axonal injury. Surgery was performed in three instances. Only seven patients were left with sequelae.
  
  
  CONCLUSIONS
  The observed skull, brain, and cranial nerve lesions corresponded to a mechanism of bilateral compression of the children's heads mainly occasioned by a static load, although an associated component of dynamic forces was also involved. The skull and its covering and the cranial nerves were the most severely affected structures while the brain seemed to be relatively well preserved. Most crush injuries appear to be preventable by the appropriate supervision of the children.
authors: Unit of Pediatric Neurosurgery and Regional Service of Neurosurgery, Virgen de Arrixaca University Hospital, 30120 El Palmar, Murcia, Spain.
authors: Antonio López
authors: AL
authors: López-Guerrero
authors: Juan F
authors: JF
authors: Martínez-Lage
authors: José
authors: J
authors: González-Tortosa
authors: María-José
authors: MJ
authors: Almagro
authors: Silvia
authors: S
authors: García-Martínez
authors: Susana B
authors: SB
authors: Reyes
mesh_terms: D000061:Accidents, Home; D000063:Accidents, Traffic; D001336:Automobiles; D001696:Biomechanical Phenomena; D001921:Brain / Q000473:pathology; D002558:Cerebrospinal Fluid Otorrhea / Q000209:etiology / Q000628:therapy; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D003422:Critical Care; D020833:Diffuse Axonal Injury / Q000209:etiology / Q000473:pathology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007427:Intracranial Pressure / Q000502:physiology; D007902:Length of Stay; D008297:Male; D019291:Skull Base / Q000473:pathology; D012887:Skull Fractures / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome