Pediatric chance fracture associated with pedicle screw use: a case report. 1997

M F Coscia
Orthopaedics Indianapolis Inc., Indiana, USA.

METHODS A previously undescribed clinic entity is presented, along with suggestions to prevent its reoccurrence. OBJECTIVE To identify a potential pitfall in the use of pedicle screw instrumentation in trauma cases. Also, to emphasize the need to identify and treat noncontiguous spinal fractures. BACKGROUND No previous cases have yet been described with this particular complication, which would be remedied easily with established methods. Pedicle screw instrumentation previously has been associated primarily with complications due to aberrant screw insertion and injury to adjoining tissues, or due to fracture of the construct itself in the absence of fusion formation. METHODS A 15-year-old girl suffered a traumatic T12-L1 fracture dislocation and paraplegia. After pedicle screw instrumentation, her apparently benign L3 fracture progressed to a severely displaced Chance fracture. This was repaired with caudal laminar hook compression instrumentation. RESULTS Postoperatively, at a 1-year follow-up, the patient's spinal deformity was completely alleviated, though she remains paraplegic. CONCLUSIONS Unstable traumatic spinal injuries treated with pedicular instrumentation should have additional laminar hook compression configuration reinforcement at the ends of the constructs to prevent further stress-induced injury from the screws alone. Instrumentation constructs should not end at even minimally fractured levels.

UI MeSH Term Description Entries
D007593 Joint Instability Lack of stability of a joint or joint prosthesis. Hypermobility, Joint,Instability, Joint,Laxity, Joint,Hypermobilities, Joint,Instabilities, Joint,Joint Hypermobilities,Joint Hypermobility,Joint Instabilities,Joint Laxities,Joint Laxity,Laxities, Joint
D007738 Kyphosis Deformities of the SPINE characterized by an exaggerated convexity of the vertebral column. The forward bending of the thoracic region usually is more than 40 degrees. This deformity sometimes is called round back or hunchback. Hyperkyphosis,Hyperkyphoses,Kyphoses
D008159 Lumbar Vertebrae VERTEBRAE in the region of the lower BACK below the THORACIC VERTEBRAE and above the SACRAL VERTEBRAE. Vertebrae, Lumbar
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D011859 Radiography Examination of any part of the body for diagnostic purposes by means of X-RAYS or GAMMA RAYS, recording the image on a sensitized surface (such as photographic film). Radiology, Diagnostic X-Ray,Roentgenography,X-Ray, Diagnostic,Diagnostic X-Ray,Diagnostic X-Ray Radiology,X-Ray Radiology, Diagnostic,Diagnostic X Ray,Diagnostic X Ray Radiology,Diagnostic X-Rays,Radiology, Diagnostic X Ray,X Ray Radiology, Diagnostic,X Ray, Diagnostic,X-Rays, Diagnostic
D012086 Reoperation A repeat operation for the same condition in the same patient due to disease progression or recurrence, or as followup to failed previous surgery. Revision, Joint,Revision, Surgical,Surgery, Repeat,Surgical Revision,Repeat Surgery,Revision Surgery,Joint Revision,Revision Surgeries,Surgery, Revision
D001863 Bone Screws Specialized devices used in ORTHOPEDIC SURGERY to repair bone fractures. Bone Screw,Screw, Bone,Screws, Bone
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000063 Accidents, Traffic Accidents on streets, roads, and highways involving drivers, passengers, pedestrians, or vehicles. Traffic accidents refer to AUTOMOBILES (passenger cars, buses, and trucks), BICYCLING, and MOTORCYCLES but not OFF-ROAD MOTOR VEHICLES; RAILROADS nor snowmobiles. Traffic Collisions,Traffic Crashes,Traffic Accidents,Accident, Traffic,Collision, Traffic,Collisions, Traffic,Crashes, Traffic,Traffic Accident,Traffic Collision
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