Seat belt fracture with late development of an enterocolic fistula in a child - A case report

Study Design. A case report of a 9-year-old boy treated at a pediatric trauma center for a flexion-extension spiral fracture with late development of an enterocolic fistula subsequent to a high-velocity motor vehicle accident. Objectives. To increase the awareness of possible delayed bowel complications associated with flexion-distraction injuries of the spine in children. Summary of Background Data. Flexion-distraction fractures of the spine in children wearing lap seat belts, so-called "Chance" fractures, are an increasingly common result of high-velocity collisions. This type of fracture, referred to as a seat-belt fracture, is often associated with duodenal or jejunal tears. Although such intra-abdominal injuries are common in such fractures secondary to this type of trauma, the occurrence of an enterocolic fistula has never been reported. Methods. A review of all pediatric Chance fractures managed at the Children's Hospital of Eastern Ontario, as well as a literature review of all reported series of flexion-distraction injuries to the spine in children, were performed. Results. The subtle and prolonged symptomatology of this lesion and its similarity to a cast syndrome is emphasized. Conclusion. Because the orthopedic surgeon is usually the primary care-giver for children with this type of seat; belt trauma, an appreciation of the possibility of a delayed onset enterocolic fistula-with its symptomatology is essential to avoid prolonged morbidity.