Undetected musculoskeletal trauma in children with traumatic brain injury or spinal cord injury.

A prospective study of 82 traumatically injured patients was conducted to determine the frequency with which skeletal trauma was undetected at acute care facilities. The clinical significance of each instance of undetected trauma on the patient's rehabilitation programs was assessed. Between May 1987 and October 1988, all trauma patients who sustained a spinal cord injury (SCI) or a severe traumatic brain injury (TBI) had total body bone scans (Tc-99mMDP) prior to beginning rehabilitation. These patients were unable to indicate pain secondary to absent sensation or cognitive impairment. In 60 children with TBI, 16 had a total of 25 newly detected fracture sites and 19 had 24 newly detected areas of soft tissue trauma. In 12 children the findings were clinically significant in that they led to behavior problems or impeded therapy. Although three new fracture sites and six soft tissue trauma sites were detected in seven children with SCI, none were clinically significant. Additionally, heterotopic ossification was detected in 14 children, of which only two sites were previously known. In three children with TBI, the area of heterotopic ossification impeded functional range of motion. Based upon this data we conclude that a total body bone scan is useful in the child with TBI for the detection of undiagnosed skeletal or soft tissue trauma and heterotopic ossification not recognized during acute care.