Asymmetrical pedicle subtraction osteotomy for progressive kyphoscoliosis caused by a pediatric Chance fracture: a case report.
BACKGROUND
Although most pediatric Chance fractures (PCFs) can be treated successfully with casting and bracing, some PCFs cause progressive spinal deformities requiring surgical treatment. There are only few reports of asymmetrical osteotomy for PCF-associated spinal deformities.


METHODS
We here report a case of a 10-year-old girl who suffered an L2 Chance fracture from an asymmetrical flexion-distraction force, accompanied by abdominal injuries. She was treated conservatively with a soft brace. However, a progressive spinal deformity became evident, and 10 months after the injury, examination showed segmental kyphoscoliosis with a Cobb angle of 36°, a kyphosis angle of 31°, and a coronal imbalance of 30 mm. Both the coronal and sagittal deformities were successfully corrected by asymmetrical pedicle subtraction osteotomy.


CONCLUSIONS
Initial kyphosis and posterior ligament complex should be evaluated at some point when treating PCFs. Asymmetrical pedicle subtraction osteotomy can be a useful surgical option when treating rigid kyphoscoliosis associated with a PCF.
Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan.
Satoshi
S
Suzuki
Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan.
Nobuyuki
N
Fujita
Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan.
Tomohiro
T
Hikata
Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan.
Akio
A
Iwanami
Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan.
Ken
K
Ishii
Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan.
Masaya
M
Nakamura
Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan.
Morio
M
Matsumoto
Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan.
Kota
0000-0002-4830-4690
K
Watanabe
Asymmetrical pedicle subtraction osteotomy; Case report; Chance fracture; Flexion-distraction injury; Kyphoscoliosis