title: Incidence and Features of Vertebral Fractures After Scalp Avulsion Injuries.
abstract: BACKGROUND
  Scalp injuries are usually extensive and may have a deleterious impact for the patient. To date, little is known in the literature about simultaneous vertebral fractures. The aim of this study was to analyze the frequency, features and pathogenesis of vertebrae fractures after scalp avulsion injuries.
  
  
  METHODS
  Between 2004 and 2014, 64 patients were retrospectively identified after scalp avulsion injuries. Patient records were reviewed for mechanism of trauma, clinical examination and neurological deficits. The features of vertebral fractures were evaluated by X-ray, computed tomography or magnetic resonance imaging, where necessary. Various treatment options were evaluated according to their injuries.
  
  
  RESULTS
  Totally, 6 women (9.4%) with a mean age 37 ± 6 years were identified with cervical fractures due to scalp avulsion injuries (mean size defect 808 ± 56 cm). Clinical examination revealed neurological deficits in 3 patients. Five patients were diagnosed with different types of C2 fracture and 1 patient was diagnosed with C7 fracture. One patient had simultaneous fractures of T3/T4. Treatment for the scalp avulsion consisted in either composite graft in 5 patients or microsurgical replantation in 1 patient. The vertebral fractures were treated by collar protection (3), cervical traction (1), HALO fixation (1), and internal stabilization (1), respectively.
  
  
  CONCLUSIONS
  Most vertebral fractures associated with scalp avulsion injuries are C2 fractures. Careful and appropriate examination is mandatory for patients with scalp avulsion injuries to exclude vertebral fractures which, if not recognized early, can have serious and devastating consequences.
authors.affiliation: *Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China †Plastic, Reconstructive, Aesthetic and Hand surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhang
authors.forename: Kaixiang
authors.initials: K
authors.lastname: Cheng
authors.forename: Jiasheng
authors.initials: J
authors.lastname: Dong
authors.forename: Qingfeng
authors.initials: Q
authors.lastname: Li
authors.forename: Mathias
authors.initials: M
authors.lastname: Tremp
authors.forename: Lian
authors.initials: L
authors.lastname: Zhu
mesh_terms: D000328:Adult; D001368:Axis, Cervical Vertebra / Q000293:injuries; D002574:Cervical Vertebrae / Q000293:injuries; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000379:methods; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009809:Odontoid Process / Q000293:injuries; D012092:Replantation / Q000379:methods; D012189:Retrospective Studies; D012535:Scalp / Q000293:injuries* / Q000601:surgery; D016038:Skin Transplantation / Q000379:methods; D016103:Spinal Fractures / Q000453:epidemiology*; D013904:Thoracic Vertebrae / Q000293:injuries; D014057:Tomography, X-Ray Computed / Q000379:methods