[Fractures of the thoracic and lumbar spine in children and adolescents]. / Frakturen der Brust- und Lendenwirbelsäule im Wachstumsalter.

BACKGROUND: Only 1.5-2% of all fractures in children and adolescents are fractures of the thoracic and lumbar spine. Treatment is most often conservative. This study compares the own experience with the recent literature. MATERIAL AND METHODS: Over a 48 month period all patients with fractures of the thoracic and lumbar spine, younger than 16 years were included prospectively. Of the patients 67 underwent follow-up investigations after 3-36 months. RESULTS: The average age of the patients was 11.9 years. Sports (53%) and traffic (28%) accidents were most frequent. Fractures most often appeared in the mid-thoracic (47%) and thoracolumbar spine (41%). Operative treatment was performed in 9 cases (10.4%). Secondary loss of alignment was not observed neither after conservative nor operative treatment. Neurological deficits (n=2) did not completely improve. CONCLUSIONS: Most fractures of the thoracic and lumbar spine heal fast and without any sequelae. Unstable fractures of type B and C (exclusively occurring as a result of traffic accidents) need operative stabilization as in adults.

Children and adolescents with posttraumatic shoulder instability benefit from arthroscopic stabilization.

INTRODUCTION: Traumatic dislocation of the shoulder in childhood is rare, accounting for only 0.01% of all injuries in this age class. However, literature does contain indications that post-traumatic instabilities and re-dislocations occur with more than average frequency in children and adolescents. MATERIAL AND METHODS: This study describes the technique and results of arthroscopic stabilization of the shoulder joint before the completion of growth. Over a period of four years, seven patients were treated prior to reaching skeletal maturity. Five patients were treated by means of arthroscopically assisted labral refixation using suture anchor systems. RESULTS: Arthroscopic labral refixation for post-traumatic shoulder instability could be carried out using the same surgical procedure as in adults. Clinical follow-up was undertaken after 12 to 48 (average 26) months using modified Constant-Murley and Rowe scores. Instability, re-dislocations and postoperative impairment of mobility did not occur after arthroscopic treatment, with an average Constant score of 92 points (Rowe score >95 points). CONCLUSION: This study demonstrated that this technique can be used successfully in children and young people prior to skeletal maturity. Considerable experience in adult shoulder reconstruction promises excellent results in children and adolescents, too. There was no evidence of growth disturbance or biodegradation-associated problems in this group of children and adolescents. Delay of labral refixation until adulthood is therefore not indicated.