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Incidence and Features of Vertebral Fractures After Scalp Avulsion Injuries

Background:Scalp injuries are usually extensive and may have a deleterious impact for the patient. To date, little is known in the literature about simultaneous vertebral fractures. The aim of this study was to analyze the frequency, features and pathogenesis of vertebrae fractures after scalp avulsion injuries. Methods:Between 2004 and 2014, 64 patients were retrospectively identified after scalp avulsion injuries. Patient records were reviewed for mechanism of trauma, clinical examination and neurological deficits. The features of vertebral fractures were evaluated by X-ray, computed tomography or magnetic resonance imaging, where necessary. Various treatment options were evaluated according to their injuries. Results:Totally, 6 women (9.4%) with a mean age 37 ± 6 years were identified with cervical fractures due to scalp avulsion injuries (mean size defect 808 ± 56 cm2). Clinical examination revealed neurological deficits in 3 patients. Five patients were diagnosed with different types of C2 fracture and 1 patient was diagnosed with C7 fracture. One patient had simultaneous fractures of T3/T4. Treatment for the scalp avulsion consisted in either composite graft in 5 patients or microsurgical replantation in 1 patient. The vertebral fractures were treated by collar protection (3), cervical traction (1), HALO fixation (1), and internal stabilization (1), respectively. Conclusions:Most vertebral fractures associated with scalp avulsion injuries are C2 fractures. Careful and appropriate examination is mandatory for patients with scalp avulsion injuries to exclude vertebral fractures which, if not recognized early, can have serious and devastating consequences.