Trauma 2
Pedestrian versus automobile - Waddell triad of injury to head, torso, and lower extremity
in  injury.

A restrained motor vehicle occupant is more likely to have chest, abdominal, pelvis, and
lumbar spine injuries.

Unrestrained occupant is more likely to have head, face, and neck injuries.

Motor vehicle crash patients with abdominal seat belt marks are at high risk for bowel
injury, pancreatic injury, Chance fractures of lumbar spine, and bladder rupture.

Handle bars hitting the abdominal wall after a bicycle injury can be associated with spleen
and liver trauma.

Fall from a height onto one’s feet can be associated with vertebral injuries at multiple
levels.

Simple blunt trauma injury, such as being punched in the epigastric area, can lead to
duodenal hematoma, pancreatic transection, hepatic contusion or laceration.
Distribution of C Spine Injuries
  Younger children tend to have higher proportion of upper cervical spine injuries (C1–C4)      
  due to the higher fulcrum of the immature spine, dislocations instead of fractures, and spinal
  cord injury without radiographic abnormality (SCIWORA).

Mechanism of injury also varies by age.
  In 0-2 years, Nonaccidental trauma and MVC
  In older children sports-related injuries and  motor vehicle collisions.

The ABCS of cervical spine radiograph interpretation
  A - Alignment - curves, malalignment, subluxation and distraction.
  B - Bone - fractures, anterior and posterior vertebral column and ossification centre
  C - Cartilage - Intervertebral disc space, ossification centres
  S - Soft Tissue - prevertebral and predental space. ( prevertebral space at C3 should be 1/2
                            to 2/3 of AP Width of adjacent vertebrae)
Trauma Mechanisms
Cervical Spine Injuries
Cervical Fractures
Jefferson fracture - bursting fracture of the ring of C1 as a result of an axial load.

Hangman’s fracture - traumatic spondylolisthesis of C2. This injury occurs as a result of
hyperextension, which fractures the posterior elements of C2.

Atlantoaxial (AA) subluxation - result of movement between C1 and C2 secondary to
transverse ligament rupture or a fractured dens

Vertebral compression injuries - isolated anterior wedging, teardrop fractures, or burst
vertebral bodies

SCIWORA < 8 years age who present with, or develop symptoms consistent with, cervical
cord injuries without any radiographic or tomographic evidence of bony abnormality.
Chance Fracture
Chance fractures are a type of spinal flexion distraction injury and are unstable fractures.  
They often involve the middle and posterior columns.

Motor vehicle accidents remain the main mechanism of injury, with falls from great height
and sports also contributing.

These are associated with intra-abdominal injuries that potentially can delay the treatment of
the spine.

They require surgical fixation.
Testicular Trauma
Ultrasonography with Doppler imaging of flow is the test of choice evaluating a child with
scrotal trauma for testicular rupture, hemorrhage or torsion.

Testicular rupture can accur with 50 kg force and requires prompt surgical consultation to
preserve hormonal and reproductive function.

Traumatic epididymitis may present 1 or more days after blunt trauma to the scrotum.
Urinary Trauma Investigations
Uretheral Trauma - Retragrade Urethrogram and Urethroscopy in females

Bladder Trauma - CT Cystogram

Renal Trauma - CT Abdomen with IV Contrast