Pediatric cervical spine fracture case report: Best practice to delay transition to rear-facing restraint

Abstract

Pediatric physicians and motor vehicle safety experts have been advocating for change in child passenger restraint practices for decades. As professional recommendations evolve to support extended rear-facing restraint, actual practices remain disparate. We report a case of pediatric cervical spine fracture due to motor vehicle collision, an uncommon, yet predictable, pattern of injury for which prevention education is undoubtedly preferable to managing the consequences of premature forward-facing in vulnerable pediatric patients. Currently, 9 kg is a minimum legal standard for forward-facing child restraint system use in Ontario, rather than a recommended transition time. We advise that parents should be counselled on the benefits of rear-facing as long as possible and discuss realistic transition times using their child restraint system manual as a reference, with the goal of approaching, but not exceeding, the maximum weight, height and fit requirements for optimal safety.

Keywords: Best practice; Case report; Motor vehicle collision; Pediatric cervical spine injury.

Fig. 1

Computed tomography images of the cervical spine. (A) Sagittal view showing the fracture extending through the neurocentral synchondrosis of C2 with subluxation of the dens onto the C2 body as well as the C2 body and dens fragments separating from the lateral masses. (B) Coronal view showing the C2 body and dens fragments displacing superiorly through the neurocentral synchondroses.

Fig. 2

Index case following closed reduction of the odontoid fracture and application of a pediatric halo-vest device.

Fig. 3

Basic schematic of head-on crash mechanics pertaining to convertible CRS for forward-facing and rear-facing systems.

Fig. 4

Weight versus age for 5th, 50th and 95th percentile boys and girls ages 0–5, WHO (2020) Growth Data; black lines indicate RFCRS weight maximums for standard available restraints.