Operative treatment of flexion-distraction fractures of the thoraco-lumbar spine in children and adolescents may be the preferred approach to the management of this fracture.

In this retrospective review of thoraco-lumbar flexion-distraction spine fractures at a paediatric level One trauma center we compared outcomes (fusion and loss of reduction) of operatively and non-operatively managed patients. Twenty cases of thoraco-lumbar and lumbar region flexion-distraction fractures were identified. Patients were grouped by non-operative versus operative and three Cobb angles were recorded from radiographs of each patient: one taken at the time of fracture, one at initiation of treatment, and the last at final follow-up. Union rate and changes in angular deformity was analysed using Chi square analysis and Fischer’s exact test.

Patients included eleven males and nine females with an average age of 13.9 (range 6 – 17). Average length of follow-up was 5.4 years. Eighty-five percent of cases involved motor-vehicle crashes with seventy percent wearing some form of seatbelt. Twenty percent had a neurological injury, all having surgery as initial management. All (100.0%) patients initially treated surgically healed with an average loss of lordosis of 7.5°. Five of the seven (71.4%) in the non-operative group developed non-union with instability and an average loss of 33.2° of reduction. All five non-unions went on to successful surgical fusion. Flexion-distraction fractures were 29.9 times more likely to heal successfully if having initial surgery (Odds ratio = 29.9, 95% C.I. 2.1 to 410.9).

Non-operative management leads to an unacceptably high rate of non-union and we recommend primary surgical management of all paediatric thoraco-lumbar flexion-distraction injuries.