Abstract
Background
Head injuries constitute one of the leading causes of pediatric morbidity and mortality. Most injuries result from accidents involving an acceleration/deceleration mechanism. However, a special type of head injury occurs when the children sustain a traumatism whose main component is a static load in relation to a crushing mechanism with the head relatively immobile.
Patients and methods
We report a series of children who sustained a craniocerebral injury of variable severity produced by head crushing. We also analyze epidemiological and clinical data, and biomechanics in these injuries.
Results
Mean age of the group (13 boys/6 girls) was 4.1 years. All patients showed external lesions (scalp wounds or hemorrhage from the nose, ears, or throat). Eleven children were initially unconscious. Six children presented cranial nerve deficits in addition to impaired hearing. Skull base fractures were seen in most cases with extension to the vault in 11 instances. Fourteen patients had an associated intracranial lesion, including two with diffuse axonal injury. Surgery was performed in three instances. Only seven patients were left with sequelae.
Discussion and conclusions
The observed skull, brain, and cranial nerve lesions corresponded to a mechanism of bilateral compression of the children’s heads mainly occasioned by a static load, although an associated component of dynamic forces was also involved. The skull and its covering and the cranial nerves were the most severely affected structures while the brain seemed to be relatively well preserved. Most crush injuries appear to be preventable by the appropriate supervision of the children.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Gottesman BL, McKenzie LB, Conner KA, Smith GA (2009) Injuries from furniture tip-overs among children and adolescents in the United States, 1990–2007. Clin Pediatr 48:851–858
Ommaya AK, Goldsmith W, Thibault L (2002) Biomechanics and neuropathology of adult and pediatric head injury. Br J Neurosurg 16:220–242
Duhaime AC, Eppley M, Margulies S, Heher KL, Barlett SP (1995) Crush injuries to the head in children. Neurosurgery 37:401–407
Gnanaraj L, Gilliand MGF, Yahya RR, Rutka JT, Drake J, Dirks P, Levin AV (2007) Ocular manifestations of crush head injury in children. Eye 21:5–10
Gonzalez Tortosa J, Martínez Pérez M, Martínez-Lage JF, Poza M (1991) Traumatismo por aplastamiento bitemporal de cráneo. Un cuadro clinico característico. Neurocirugía (Astur) 2:17–24
Gonzalez Tortosa J, Martínez-Lage JF, Poza M (2004) Bitemporal head crush injuries: clinical and radiological features of a distinctive type of head injury. J Neurosurg 100:645–651
Russell WR, Schiller F (1949) Crushing injuries to the skull: clinical and experimental observations. J Neurol Neurosurg Psychiat 12:52–60
Bernard PA, Johnston C, Curtis SE, King WD (1998) Toppled television sets cause significant pediatric morbidity and mortality. Pediatrics 102:e3
Deisch J, Quinton R, Gruszecki AC (2011) Craniocerebral trauma inflicted by television falls. J Forensic Sci 56:1049–1053
Gokhan S, Kose O, Ozhaseneckler A, Orak M, Ustundag M, Guloglu C (2010) Mortality and morbidity in children caused by falling televisions: a retrospective analysis of 71 cases. Int J Emerg Med 3:305–308
Jea A, Ragheb J, Morrison G (2003) Television tipovers as a significant source of pediatric head injury. Pediatr Neurosurg 38:191–194
Marnewick J, Dansey R, Morreau P, Hamill J (2011) Television tip-overs: the Starship Children’s Hospital experience and literature review. Injury 42:534–538
Murray KJ, Griffin R, Rue LW 3rd, McGwin G Jr (2009) Recent trends in television tip over-related injuries among children aged 0–9 years. Inj Prev 15:240–243
Rutkoski JD, Sippey M, Gaines BA (2011) Traumatic television tip-overs in the pediatric population. J Surg Res 166:199204
Schleider MG, Schultz BL, Schall L, Vyas A, Barksdale EM Jr (2002) Falling televisions: the hidden danger for children. J Pediatr Surg 37:572–575
Suresh N, Harini G, Radhika R, Chidambaram B (2010) Head injuries in children resulting from the fall of television. Indian J Pediatr 77:459–460
Yahya RR, Dirks P, Humphreys R, Rutka JT, Taylor M, Drake JM (2005) Children and television tipovers: a significant and preventable cause of long-term neurological deficits. J Neurosurg (Pediatrics 3) 103:219–222
Ochalski PG, Adamo MA, Adelson PD, Okonkwo DO, Pollack IF (2011) Fractures of the clivus and traumatic diastasis of the central skull base in the pediatric population. J Neurosurg Pediatrics 7:261–267
Summers CG, Wirtschafter JD (1979) Bilateral trigeminal and abducens neuropathies following low-velocity, crushing head injury. J Neurosurg 50:508–511
Brison RJ, Pickett W, Berg RL, Linneman J, Zentner J, Marlenga B (2006) Fatal agricultural injuries in preschool children; risks, injury patterns and strategies for prevention. CMAJ 174:1732–1736
Partrick DA, Bensard DD, Moore EE, Partington MD, Karrer FM (1998) Driveway crush injuries in young children: a highly lethal, devastating, and potentially preventable event. J Pediatr Surg 33:1712–1715
Graham DI, Ford I, Adams JH, Doyle D, Lawrence AE, McLellan DR (1989) Fatal head injury in children. J Clin Pathol 42:18–22
Prasad MR, Ewing-Cobbs L, Baumgartner J (1999) Crush head injuries in infants and young children: neurologic and neuropsychologic sequelae. J Child Neurol 14:496–501
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
López-Guerrero, A.L., Martínez-Lage, J.F., González-Tortosa, J. et al. Pediatric crushing head injury: biomechanics and clinical features of an uncommon type of craniocerebral trauma. Childs Nerv Syst 28, 2033–2040 (2012). https://doi.org/10.1007/s00381-012-1864-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-012-1864-z