JRSM > Volume 95, Number 11 > Pp. 553-554

This Article Figures Only Full Text (PDF) Send a Quick Comment Alert me when this article is cited Alert me when Quick Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mohammed, A H Articles by Buxton, T S Search for Related Content PubMed PubMed Citation Social Bookmarking                      What's this?

Ventriculoperitoneal shunt fractured by a closing car window

A H Mohammed MB ChB   V P Sivasamy FRCS   S Griffiths FRCS     T S Buxton FRCS  

Department of Neurosurgery, Morriston Hospital, Swansea, UK

Correspondence to: A H Mohammed, 1 Llys Gwenci, Birchgrove, Swansea SA7 9NE, UK E-mail: drausama{at}aol.com

Motorized car windows can present hazards to children. We report a new one.

CASE HISTORY

A 5-year-old boy was referred with headache, lethargy, nausea and vomiting. At age one month he had had a ventriculoperitoneal shunt inserted for postnatal haemorrhagic hydrocephalus. The present symptoms had developed six days after an incident described by the parents. While unsupervised in the car the child had accidentally activated a window switch and caught his neck between the door frame and the closing window. On admission he was drowsy and confused, localizing to pain and opening his eyes to verbal command with a convergent squint. Radiographs showed that the shunt tube had fractured just distal to the clavicle (Figure 1). On a CT scan the ventricles were no bigger than previously. The shunt was revised and the old tube showed a transverse fracture. The child was discharged three days later without residual focal neurological deficit.

View larger version (114K): [in this window] [in a new window]   Figure 1. Chest X-ray showing tube fracture

 

COMMENT

There is one previously reported case of shunt malfunction related to automobiles. That was caused by the seat belt rubbing against the tube in the neck on a long journey¹. Shunt fracture or disconnection is the second most frequent cause of shunt malfunction in children². Peritoneal catheter fractures occur most commonly in the neck, the area where the tube is most subject to mechanical stress³.

The window operating systems in cars vary between manufacturers. From the safety point of view, switch type and position are of paramount importance. Prominent horizontally mounted buttons such as that shown in Figure 2, especially when on door handles, are likely to have the highest rate of accidental activation: children may step on the door handle or hang on to it. There are hazards even for children who do not have shunts, and we suggest the following precautions for parents considering purchasing a car with motorized windows: check that the system has a pressure-sensitive cut-out that inactivates the closing window on meeting resistance; make sure the system is disabled when the ignition is turned off; the safest switches are probably those that need to be lifted to close the window; be extra cautious with systems that operate with a one-shot closure feature, where the window continues to full closure after a single activation of the switch; take notice of the position of the switches and the likelihood of their being accidentally activated by young children.

View larger version (141K): [in this window] [in a new window]   Figure 2. Switch on car in which the injury was sustained

 

REFERENCES

1. Walker DG, Coyne TJ. Peritoneal catheter fracture caused by a seatbelt. Med J Aust1997; 167:512 [letter][Medline]

2. Cuka GM, Hellbusch LC. Fractures of the peritoneal catheter of cerebrospinal fluid shunts. Pediatr Neurosurg1995; 22:101 -3[Medline]

3. Drake JM, Sainte-Rose C. The Shunt Book. Cambridge: Blackwell Science, 1995

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This Article Figures Only Full Text (PDF) Send a Quick Comment Alert me when this article is cited Alert me when Quick Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mohammed, A H Articles by Buxton, T S Search for Related Content PubMed PubMed Citation Social Bookmarking                      What's this?