P Domenech-Fernandez1,2, J Yamane3, J Domenech4, C Barrios5, F Soldado-Carrera6, J Knorr6, F Canavese7. 1. Department of Orthopaedic Surgery, Hospital Universitario y Politécnico La Fe, Doctorate School, Universidad católica de Valencia san vicente martir, Av. Fernando Abril Martorell, nº 106, 46026, Valencia, C. Valenciana, España. pdomenechf@gmail.com. 2. School of Doctorate, Universidad Católica de Valencia San Vicente Martir, Valencia, Spain. pdomenechf@gmail.com. 3. Department of Orthopaedic Surgery, National Hospital Organization Murayama Medical Center, Keio University, Tokyo, Japan. 4. Department of Orthopaedic Surgery. Hospital Arnau de Vilanova, Universidad CEU-Cardenal Herrera, Valencia, Spain. 5. School of Doctorate, Universidad Católica de Valencia San Vicente Martir, Valencia, Spain. 6. Department of Pediatric Orthopedic Surgery, Hospital Universitario Valle de Hebron, Barcelona, Spain. 7. Department of Pediatric Orthopedic Surgery, University Hospital Estaing, Clermont Ferrand, France.
Abstract
PURPOSE: To assess skull bone thickness from birth to skeletal maturity at different sites to provide a reference for the correct selection of pin type and pin placement according to age. METHODS: 270 children and adolescents (age: 0-17 years) with a normal CT scan obtained at Emergency Department for other medical reasons were included. Skull thickness was measured on the axial plane CT scans at eight different sites of the vault: midline anterior (A) and posterior (P), right and left lateral (L), antero-lateral (AL), postero-lateral (PL). RESULTS: From birth to skeletal maturity, L thickness was increased significantly less (+ 58%) compared with AL (+ 205%), P (+ 233%), PL (+ 247%), and A (+ 269%) thickness (P < 0.01). At the end of growth, the thickest and thinnest points of the vault (absolute value) were found at the P and L measurement sites, respectively (P < 0.01). Children aged < 4 years exhibited the highest variability in AL and PL skull bone thickness, with thickness < 3 mm observed in 85% (64/75 patients) and 92% (69/75 patients) of cases, respectively. CONCLUSION: We recommend that the tip of the pin should not exceed 2-3 mm in children aged < 4, and 4 mm in children aged 4-6 years, to decrease the risk of inner table perforation. After the age of 7 years and 13 years, standard-sized pin tips (5 and 6 mm, respectively) may be safely used. Children aged < 4 years show significant variability in skull thickness, and therefore a CT scan may be required for this particular age group.
PURPOSE: To assess skull bone thickness from birth to skeletal maturity at different sites to provide a reference for the correct selection of pin type and pin placement according to age. METHODS: 270 children and adolescents (age: 0-17 years) with a normal CT scan obtained at Emergency Department for other medical reasons were included. Skull thickness was measured on the axial plane CT scans at eight different sites of the vault: midline anterior (A) and posterior (P), right and left lateral (L), antero-lateral (AL), postero-lateral (PL). RESULTS: From birth to skeletal maturity, L thickness was increased significantly less (+ 58%) compared with AL (+ 205%), P (+ 233%), PL (+ 247%), and A (+ 269%) thickness (P < 0.01). At the end of growth, the thickest and thinnest points of the vault (absolute value) were found at the P and L measurement sites, respectively (P < 0.01). Children aged < 4 years exhibited the highest variability in AL and PL skull bone thickness, with thickness < 3 mm observed in 85% (64/75 patients) and 92% (69/75 patients) of cases, respectively. CONCLUSION: We recommend that the tip of the pin should not exceed 2-3 mm in children aged < 4, and 4 mm in children aged 4-6 years, to decrease the risk of inner table perforation. After the age of 7 years and 13 years, standard-sized pin tips (5 and 6 mm, respectively) may be safely used. Children aged < 4 years show significant variability in skull thickness, and therefore a CT scan may be required for this particular age group.
Entities:
Keywords:
Bone growth; Children spine; Cranial thickness; Halo; Skull development; Spine surgery
Authors: Victor M Hayes; Jeff S Silber; Farhan N Siddiqi; Dmitriy Kondrachov; Jason S Lipetz; Baron Lonner Journal: Am J Orthop (Belle Mead NJ) Date: 2005-06