• P Domenech-Fernandez, J Yamane, J Domenech, C Barrios, F Soldado-Carrera, J Knorr, and F Canavese.
• 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.
• Eur Spine J. 2021 Feb 1; 30 (2): 410-415.

PurposeTo 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.Methods270 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).ResultsFrom 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.ConclusionWe 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.

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