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Crush Injuries to the Head in Children

Duhaime, Ann-Christine M.D.; Eppley, Matthew M.D.; Margulies, Susan Ph.D.; Heher, Katrinka L. M.D.; Bartlett, Scott P. M.D.

Clinical Study

ALTHOUGH THE MAJORITY of head injuries in children and adults involve dynamic loading conditions, some patients suffer static loading. Static loading occurs when forces are applied slowly to the head, and it produces a much different pattern of injuries. Crush injuries are usually described in the context of industrial accidents, but in our experience, these injuries are not rare in children. We report a series of seven crush injuries in young children admitted during a period of 29 months and describe our experience in the evaluation and treatment of this complex entity. Patient ages ranged from 15 months to 6 years. In four cases, the child's head was run over by a motor vehicle backing up in a driveway or parking lot. In the three other patients, the static loading occurred when the child climbed or pulled on a heavy object, which then fell over with the child and landed on the child's head. One child with cervicomedullary disruption died shortly after his arrival at the hospital. The others showed varying degrees of soft tissue injury to the face and scalp, with Glasgow Coma Scale scores ranging from 7 to 15. Computed tomograms and magnetic resonance images showed multiple and often extensive comminuted calvarial fractures, as well as subarachnoid and parenchymal hemorrhages. All patients had basilar cranial fractures. There was one cervical spine injury but no major vascular injuries. One child had pituitary transection, four had cranial nerve palsies, and another developed a delayed cerebrospinal fluid rhinorrhea 18 months after injury. All children made good cognitive recoveries, with some having relatively mild fixed focal deficits. Despite their alarming initial history and appearance, children who survive the acute period of a crush injury to the head have a good long-term prognosis, reflecting the ability of the brain and cranium to withstand quasi-static loading even in the early years of life.

Divisions of Neurosurgery (A-CD, ME), Ophthalmology (KLH), and Plastic Surgery (SPB), Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, and Department of Bioengineering (SM), University of Pennsylvania, Philadelphia, Pennsylvania

Reprint requests: Ann-Christine Duhaime, M.D., Division of Neurosurgery, Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104.

Received, July 28, 1994. Accepted, March 29, 1995.

Copyright © by the Congress of Neurological Surgeons