Wayne County Medical Examiner's Office, Michigan Medicine, 1300 Warren Avenue, Detroit, Michigan, 48207.
Exponent, Farmington Hills, Michigan, 48331.
J Forensic Sci. 2020 Nov;65(6):2023-2029. doi: 10.1111/1556-4029.14521. Epub 2020 Aug 17.
Pediatric thoracolumbar fractures are rare due to the physiological differences which afford greater resilience to the immature spine. Most pediatric thoracolumbar fractures occur as the result of high energy trauma, such as motor vehicle accidents, and modes of reasonable accidental injuries are limited by age and developmental capabilities of the child. These fractures can occur as the result of inflicted blunt force trauma and child abuse, and in most cases, the mechanism of injury to the spine is not known. We report the death of a 29-month-old man due to blunt force trauma to the back and forced hyperextension of the thoracolumbar spine causing fracture of the fourth lumbar (L4) vertebral body. A complete forensic examination revealed a previous healing fracture of the anterior aspect of the L4 vertebral body, with acute disruption of the anterior longitudinal ligament overlying the fracture site, complete fracture of the vertebral body, and fatal retroperitoneal hemorrhage. We present a review of the biomechanical considerations of the pediatric spine, a survey of pediatric spinal fractures, and a review of the literature on pediatric abusive thoracolumbar fractures. In this case, there was never a provided explanation for how the injury occurred; however, understanding the biomechanics of the pediatric spine allowed for the determination of the mechanism, force required to produce this specific pattern of abusive spinal injury, and the manner of death.
小儿胸腰椎骨折较为罕见，这是由于小儿脊柱具有较大的弹性，存在生理性差异。大多数小儿胸腰椎骨折是由高能外伤引起的，如交通事故，而合理的意外损伤模式则受到儿童年龄和发育能力的限制。这些骨折可由钝器伤和虐待引起，在大多数情况下，脊柱损伤的机制尚不清楚。我们报告了一例 29 个月大的男性，因背部受到钝器伤和强制性过度伸展胸腰椎而导致第四腰椎（L4）椎体骨折而死亡。全面的法医检查显示，先前 L4 椎体前侧有一处愈合性骨折，骨折部位上方的前纵韧带急性断裂，椎体完全骨折，并伴有致命性腹膜后出血。我们回顾了小儿脊柱的生物力学考虑因素，对小儿脊柱骨折进行了调查，并对小儿虐待性胸腰椎骨折的文献进行了回顾。在这种情况下，从未提供过受伤是如何发生的解释；然而，了解小儿脊柱的生物力学特性有助于确定导致这种特定类型虐待性脊柱损伤的机制、所需的力以及死亡方式。
