An abused five-month-old girl: Hangman’s fracture or congenital arch defect?

Rijn, Rick R. van; Kool, Digna R.; Hamer, Philip C. De Witt; Majoie, Charles B. L. M.

doi:10.1016/j.jemermed.2005.01.008

Cited by 17 publications

(8 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This mobility may justify a tendency toward anterolisthesis as well as the greater rate of dislocations, rather than fractures, found in younger children [19] . Younger children also have a higher center of gravity due to a relatively larger head mass that provides a higher pivot for cervical movement around C 2-3 , compared to the pivot of motion for adolescents and adults around C [5][6] [14,20] . This higher pivot point may explain the lessened occurrence of lower cervical spine injuries as well as higher incidence of upper cervical lesions in children [19] .…”

Section: Pediatric Prevalencementioning

confidence: 99%

“…A callus formation on additional imaging or prevertebral hematoma would be more suggestive of a traumatic spondylolisthesis ( Fig. 5 , 6 ) [6,11] . Another finding that may present as a radiological discrepancy is pseudosubluxation.…”

Section: Diagnosis and Differential Diagnosesmentioning

confidence: 99%

“…Another finding that may present as a radiological discrepancy is pseudosubluxation. This can present with anterolisthesis of C 2 of more than 3 mm and may be a normal variant present in up to 24% of children under the age of 8 [6] . Differentiation between this condition and the anterolisthesis of hangman's fracture can be established by measuring angulation via lines drawn perpendicularly to the inferior end plate of C 2 and C 3 [23] .…”

Section: Diagnosis and Differential Diagnosesmentioning

confidence: 99%

“…These authors described the lesion as an avulsion of the neural arch of C 2 along the stress points of the weakest elements, i.e. the pars articularis, and concomitant anterolisthesis of the vertebral body of C 2 , usually sparing the odontoid process [4][5][6] .…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Pediatric Hangman's Fracture: A Comprehensive Review

Montalbano¹,

Fisahn²,

Loukas³

et al. 2017

Pediatr Neurosurg

View full text Add to dashboard Cite

Purpose: Over 170 years ago, traumatic spondylolisthesis of the axis or hangman's fracture was described. Most descriptions of this entity have focused on adult presentations. Methods: We review the literature on pediatric cases of hangman's fracture emphasizing the embryological as well as presentation aspects. Results: The majority of cervical spine fractures in children occur at C₁ and C₂ vertebrae. A normal anterolisthesis of C₂ can be seen in younger children and can mimic the anterolisthesis seen after traumatic spondylolisthesis. Conclusions: Traumatic spondylolisthesis of the axis in children requires further investigation due to the current emphasis in the literature on adult clinical findings and diagnostic challenges from the developmental immaturity of the pediatric skeleton.

show abstract

Section: Pediatric Prevalencementioning

confidence: 99%

Section: Diagnosis and Differential Diagnosesmentioning

confidence: 99%

Section: Diagnosis and Differential Diagnosesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pediatric Hangman's Fracture: A Comprehensive Review

Montalbano¹,

Fisahn²,

Loukas³

et al. 2017

Pediatr Neurosurg

View full text Add to dashboard Cite

show abstract

“…4,5,8,9,11,13,14,[17][18][19]22,24,29,[31][32][33][34] Most cases are diagnosed in adulthood. 6,7,13,20,23,25,27,28,30 There are even fewer longitudinal studies examining the long-term implications and natural history of this bony defect in the immature spine of very young children (3 years of age or younger).…”

mentioning

confidence: 99%

Spondylolysis of C-2 in children 3 years of age or younger: clinical presentation, radiographic findings, management, and outcomes with a minimum 12-month follow-up

Gressot

Vadivelu

Hwang

et al. 2014

PED

View full text Add to dashboard Cite

Object Cervical spondylolysis is a rare condition that results from a pars interarticularis defect. The C-6 level is the most frequently involved site in the cervical spine. Its clinical presentations range from incidental radiographic findings to neck pain and, rarely, neurological deficits. Although 150 patients with subaxial cervical spondylolysis have been reported, a mere 24 adult and pediatric patients with C-2 spondylolysis have been described. The long-term outcomes of very young children with bilateral C-2 spondylolysis are of great interest, yet only a few longitudinal studies exist. Methods The authors retrospectively reviewed 5 cases of bilateral C-2 spondylolysis at Texas Children's Hospital and Riley Children's Hospital; these were combined with 5 other cases in the literature, yielding a total of 10 patients. Data regarding the patients' age, sex, C2–3 angulation and displacement, associated spine anomalies, neurological deficits, treatment, and most recent follow-up were recorded. Results The patients' ages ranged from 3 to 36 months (mean 12.9 months). There were 6 boys and 4 girls. The C2–3 angulation, displacement, and width of pars defect were measured when available. The mean C2–3 angulation was 9.5° (range 1–34°), the mean C2–3 displacement was 4.78 mm (range 1.1–10.8 mm), and the mean width of the pars defect was 4.16 mm (range 0.9–7 mm). One patient developed myelopathy and spinal cord injury. All 10 of the patients were treated initially with conservative therapy: 3 with close observation alone, 1 with a rigid cervical collar, 4 with a Minerva jacket, 1 with a sternal-occipital-mandibular immobilizer, and 1 with a halo vest. Three patients ultimately underwent surgery for internal fixation due to progressive instability or development of neurological symptoms. All patients were neurologically intact at the last follow-up (mean 44.3 months, range 14–120 months). Conclusions Based on the literature and the authors' own experience, they conclude that most very young children with C-2 spondylolysis remain neurologically intact and maintain stability in long-term follow-up despite the bony defect. This defect is often an asymptomatic incidental finding and may be managed conservatively. More aggressive therapy including surgery is indicated for those patients with a neurological deficit from spinal cord compromise secondary to stenosis and local C-2 kyphosis, progressive deformity, or worsening C2–3 instability.