PubMed · 1422408
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C Illingworth. 1992-10-10. The argument for helmets.. https://doi.org/10.1136/bmj.305.6858.882
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Motor-vehicle-related injuries are the leading cause of death for persons aged 1-24 years in the United States. Although the relation between alcohol use and motor-vehicle-related deaths involving teenagers is well established, understanding of the role of alcohol in such deaths among younger children is limited. To characterize the involvement of alcohol in motor-vehicle-related deaths of U.S. children aged <15 years during 1985-1996, CDC analyzed data from the Fatality Analysis Reporting System (FARS) of the National Highway Traffic Safety Administration (NHTSA). This report summarizes the results of that analysis, which indicate that approximately one fourth of all traffic deaths among children aged <15 years involved alcohol and that in nearly two thirds of passenger deaths involving a legally drunk driver, the child was in the car driven by the legally drunk driver.
The table and figure on page 1155 compare alcohol involvement in fatal motor-vehicle crashes for 1995 and 1996. A fatal crash is considered alcohol-related by the National Highway Traffic Safety Administration (NHTSA) if either a driver or non-occupant (e.g., pedestrian) had a blood alcohol concentration (BAC) of > or = 0.01 g/dL in a police-reported traffic crash. Because BACs are not available for all persons in fatal crashes, NHTSA estimates the number of alcohol-related traffic fatalities based on a discriminant analysis of information from all cases for which driver or nonoccupant BAC data are available.
STUDY DESIGN: 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. SUMMARY OF BACKGROUND DATA: 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.