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Spinal injuries in the battered child
Volume I Number 3
GISSANE ET AL.." SEQUELAE OF ROAD INJURIES
cent o f the total cost o f r o a d accidents to the c o m m u n i t y . Hospital costs in a large accident service such as the B i r m i n g h a m A c c i d e n t Hospital t r e a t i n g 40-50,000 injured people each year are p e r h a p s less t h a n the cost o f such t r e a t m e n t in smaller hospitals. In this study it is considered t h a t the in-patient t r e a t m e n t costs averaged £72 per r o a d accident at 1961 prices. T o this s h o u l d be a d d e d a f u r t h e r £3 per case for o u t - p a t i e n t attendances. R o a d accidents treated only as out-patients cost a b o u t £2 per patient. O n this basis the total of 4342 patients cost the hospital £101,250. C u r r e n t costs w o u l d be a b o u t 30 per cent higher. T h e total cost to the c o m m u n i t y w o u l d include such items as lost p r o d u c t i o n , lost wages, c o m p e n s a t i o n , legal procedures, r e t r a i n i n g p r o g r a m m e s . T h e n a t i o n a l cost o f
203
r o a d accidents for 1967 has been e s t i m a t e d at £232 million.
Acknowledgements This w o r k is s u p p o r t e d by a g r a n t from the A u t o m o b i l e Association. W e also wish to t h a n k o u r clinical colleagues a n d the hospital Records D e p a r t m e n t for their help. REFERENCES
GISSANE,W., and BULL, J. (1961), ' A Study of 183 Road Deaths in and around Birmingham in 1960 ', Br. reed. J., 1, 1716. (1962), ' Injuries from Road Accidents ', Practitioner, 188, 489. SEvrrr, S. (1968), ' Fatal Road Accidents. Injuries, Complications, and Causes of Death in 250 Subjects ', Br..I. Sarg., 55, 481.
Requests for reprhlts shouM be addressed to:--Miss B. J. Roberts. Road Injuries Research Group, Birmingham Accident Hospital, Birmingham 15.
ABSTRACTS SPINAL INJURIES
A New Sign of Spondylolisthesis This sign consists of malalinement of the synovial joints and is shown by forward displacement of the superior articular facets of the vertebrae involved. Of 50 patients with suspected spondylolisthesis, 23 were found to have this condition and a positive malalinement was present in 21. There were no false positives. The sign is helpful in making a definite radiological diagnosis when only a minor degree of spondylolisthesis is present. APPLEBY,A., and STABLER,J. (1969), ' A New Sign of Spondylolisthesis ', Clin. Radiol., 20, 315.
Treatment of Spinal Cord Injury In a lecture on management of the patient with injury to the spinal cord, Dr. White reported success in the treatment of 35 monkeys with spinal cord injury by laminectomy and cooling of the wound cavity by perfusion with cold saline for 3 hours. He explains these startling results by the direct result of cold, i.e., reduction of oxygen requirements of cord tissue, reduction in bleeding, and diminution in oedema. Two patients were treated in this manner without effect but the time element was too great, i.e., more than 6 hours after injury. All the successfully treated experimental animals were treated within 4 hours of injury. Dr. White has made a very convincing case for his ideas on the early treatment of the patient with an incomplete section of the cord. WHITE, R. J. (1969), 'Prevention of Paralysis following Spinal Cord Injury in Monkeys ', J. Am. med. Ass., 207, 259.
Paraplegia among Children The writer reports the experience of the National Spinal Injuries Centre of 93 paraplegic children dealt with there since 1948. A third owed their paralysis to tumour or spina bifida and almost as many to injury. In 16 of the 29 children that had traumatic paraplegia, no fracture could be detected. In 1 case fracture was recognized only when displacement occurred after laminectomy. The children are cared for in 1-, 2-, or 4-bed rooms in a 12-bed unit with its own operating room, playroom, and toilet facilities. The policy of management differs from that for adults only in including means of educating the children. MELZAK, J. (1969), ' Paraplegia among Children ', Lancet, 2, 45.
Spinal Injuries in the Battered Child Descriptions are given of 6 cases of battered child syndrome with spinal injury and 1 with both spine and spinal cord injury. The mechanism appears to be hyperflexion and radiographs showed intervertebral disk space narrowing and anterior vertebral notching at the thoracolumbar junction. In 2 patients, there were simple vertebral body compression fractures and 1 with actual fracture-dislocation of the spine. The mechanism of this anterior notching is not clear but thought to represent anterior herniation of the nucleus pulposus with associated compression of the anterior superior vertebral plate. However, this finding has occasionally been seen in asymptomatic children and it is postulated that repeated trauma is required for the final fracture rather than one specific episode. In all the cases described there was other evidence of injury ranging from skin bruising to metaphysial fractures and subdural haematoma. SwIscr-IoK, L. E. (1969), ' S p i n e and Spinal Cord Trauma in the Battered Child Syndrome ', Radiology, 92, 733.
GISSANE ET AL.." SEQUELAE OF ROAD INJURIES
cent o f the total cost o f r o a d accidents to the c o m m u n i t y . Hospital costs in a large accident service such as the B i r m i n g h a m A c c i d e n t Hospital t r e a t i n g 40-50,000 injured people each year are p e r h a p s less t h a n the cost o f such t r e a t m e n t in smaller hospitals. In this study it is considered t h a t the in-patient t r e a t m e n t costs averaged £72 per r o a d accident at 1961 prices. T o this s h o u l d be a d d e d a f u r t h e r £3 per case for o u t - p a t i e n t attendances. R o a d accidents treated only as out-patients cost a b o u t £2 per patient. O n this basis the total of 4342 patients cost the hospital £101,250. C u r r e n t costs w o u l d be a b o u t 30 per cent higher. T h e total cost to the c o m m u n i t y w o u l d include such items as lost p r o d u c t i o n , lost wages, c o m p e n s a t i o n , legal procedures, r e t r a i n i n g p r o g r a m m e s . T h e n a t i o n a l cost o f
203
r o a d accidents for 1967 has been e s t i m a t e d at £232 million.
Acknowledgements This w o r k is s u p p o r t e d by a g r a n t from the A u t o m o b i l e Association. W e also wish to t h a n k o u r clinical colleagues a n d the hospital Records D e p a r t m e n t for their help. REFERENCES
GISSANE,W., and BULL, J. (1961), ' A Study of 183 Road Deaths in and around Birmingham in 1960 ', Br. reed. J., 1, 1716. (1962), ' Injuries from Road Accidents ', Practitioner, 188, 489. SEvrrr, S. (1968), ' Fatal Road Accidents. Injuries, Complications, and Causes of Death in 250 Subjects ', Br..I. Sarg., 55, 481.
Requests for reprhlts shouM be addressed to:--Miss B. J. Roberts. Road Injuries Research Group, Birmingham Accident Hospital, Birmingham 15.
ABSTRACTS SPINAL INJURIES
A New Sign of Spondylolisthesis This sign consists of malalinement of the synovial joints and is shown by forward displacement of the superior articular facets of the vertebrae involved. Of 50 patients with suspected spondylolisthesis, 23 were found to have this condition and a positive malalinement was present in 21. There were no false positives. The sign is helpful in making a definite radiological diagnosis when only a minor degree of spondylolisthesis is present. APPLEBY,A., and STABLER,J. (1969), ' A New Sign of Spondylolisthesis ', Clin. Radiol., 20, 315.
Treatment of Spinal Cord Injury In a lecture on management of the patient with injury to the spinal cord, Dr. White reported success in the treatment of 35 monkeys with spinal cord injury by laminectomy and cooling of the wound cavity by perfusion with cold saline for 3 hours. He explains these startling results by the direct result of cold, i.e., reduction of oxygen requirements of cord tissue, reduction in bleeding, and diminution in oedema. Two patients were treated in this manner without effect but the time element was too great, i.e., more than 6 hours after injury. All the successfully treated experimental animals were treated within 4 hours of injury. Dr. White has made a very convincing case for his ideas on the early treatment of the patient with an incomplete section of the cord. WHITE, R. J. (1969), 'Prevention of Paralysis following Spinal Cord Injury in Monkeys ', J. Am. med. Ass., 207, 259.
Paraplegia among Children The writer reports the experience of the National Spinal Injuries Centre of 93 paraplegic children dealt with there since 1948. A third owed their paralysis to tumour or spina bifida and almost as many to injury. In 16 of the 29 children that had traumatic paraplegia, no fracture could be detected. In 1 case fracture was recognized only when displacement occurred after laminectomy. The children are cared for in 1-, 2-, or 4-bed rooms in a 12-bed unit with its own operating room, playroom, and toilet facilities. The policy of management differs from that for adults only in including means of educating the children. MELZAK, J. (1969), ' Paraplegia among Children ', Lancet, 2, 45.
Spinal Injuries in the Battered Child Descriptions are given of 6 cases of battered child syndrome with spinal injury and 1 with both spine and spinal cord injury. The mechanism appears to be hyperflexion and radiographs showed intervertebral disk space narrowing and anterior vertebral notching at the thoracolumbar junction. In 2 patients, there were simple vertebral body compression fractures and 1 with actual fracture-dislocation of the spine. The mechanism of this anterior notching is not clear but thought to represent anterior herniation of the nucleus pulposus with associated compression of the anterior superior vertebral plate. However, this finding has occasionally been seen in asymptomatic children and it is postulated that repeated trauma is required for the final fracture rather than one specific episode. In all the cases described there was other evidence of injury ranging from skin bruising to metaphysial fractures and subdural haematoma. SwIscr-IoK, L. E. (1969), ' S p i n e and Spinal Cord Trauma in the Battered Child Syndrome ', Radiology, 92, 733.