Special considerations in pediatric cranial fixation: a technical overview.

Advances in plate fixation design have made possible traumatic and elective cranial reconstruction in pediatric patients. Plating systems must be selected properly, particularly in growing infants and children, in whom long-term computerized axial tomography (CAT) scanning and magnetic resonance imaging (MRI) may be necessary. Specific concerns include an actively growing skull with resulting dynamic bony contour changes. The results of 41 children with approximately 5 plates per case, totaling 205 implantable devices, were studied. This article addresses safety and image quality of metallic implants on CAT scan and MRI scanning, growth restriction induced by rigid plating systems, passive internal displacement of plates and screws with possible dural and cortical penetration, plate and screw isolation, and recommendations for cranial fixation in children.