A Deformed Vertebra Due to a Fracture Could Be Remodelled by Growth in Young But Not in Old Children - An Up to 47 Years Follow-Up

Introduction: We have previously, in a preliminary report, suggested that a fractured vertebra could be remodelled in young children The purpose of this study was to (i) extend the database and evaluate if the remodelling capacity occur only in children with a large remaining growth potential, (ii) evaluate the incidence, (iii) the clinical and (iv) the radiological long-term outcome of vertebral fractures in children.

Materials and Methods: At our University Hospital, the only emergency hospital in a city of 225 00 inhabitants, radiographs are saved since the beginning of last century, leaving the opportunity to re-examine and classify old fractures. All patients with a traumatic vertebral fracture 1950-1972, <18 years at injury, still city residents were invited to the study. Four denied, leaving 28 boys and 18 girls with mean age 14 (range 7 - 18) fracture, 36 stable one column compression fractures, Denis A, 8 B Chance all but without neurological deficits, be re-examined after 33 27 47). All non operatively treated. Followup included subjective (Oswestry score), objective (Frankel score) radiographic outcome.

Results: Epidemiology: The incidence of thoracic and lumbar vertebral fractures was 0.07 ‰ in children age 16 at injury.

Subjective: Thirty-nine individuals had at follow-up no subjective complaints, seven had occasional back pain (mean Oswestry 15, range 8 - 28), with no difference found when comparing children below or above age 16 at injury.

Objective: Forty-two individuals were classified Frankel E and 4 Frankel D, one below age 16 and 3 above age 16 at injury. Radiographic: The radiographic ratio anterior height / posterior height in the fractured vertebra increased from 0.75 at fracture to 0.87 at follow-up in children

Conclusion: Non operatively treated one column compression fractures, burst fractures Denis A and B and Chance fractures in children without neurological deficits have a predominantly favourable long-term outcome. A modelling capacity, reducing the fracture deformity, exist in children with a large remaining growth potential.