Cranial impalement in a child driving an all-terrain vehicle.

BACKGROUND All-terrain vehicle (ATV) injury is a serious problem in children and adolescents. We report an unusual case of a child with cranial impalement in a rollover ATV crash. CASE An 8-year-old, reportedly helmeted, was driving an ATV uphill when it rolled over causing cranial impalement of the brake handle just above the left ear. The child was awake and alert at the scene and on arrival in the pediatric emergency department. The child was taken to the operating room where he underwent fiber-optic intubation followed by removal of the brake handle. He was discharged home after 3 days with a normal neurological examination. CONCLUSIONS All-terrain vehicle injury is an increasing problem in children. This case demonstrates that serious injury can occur even while wearing a helmet. The case demonstrates the dangers associated with children driving or riding ATVs.