Delayed displacement of a paediatric atlas fracture through the synchondrosis after minor trauma

Kapoor, V.; Watts, Beverley; Theruvil, Bipin; Boeree, Nick; Fairhurst, Joanna

doi:10.1016/s0020-1383(03)00205-5

Cited by 8 publications

(10 citation statements)

References 3 publications

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“…2,3,8,10,11,13,18,21,23 Contemporary clinical experience with fractures of the immature atlas has indicated that they present-often in a delayed fashion-with neck pain and torticollis after injuries of sometimes trivial severity.…”

Section: Elliottmentioning

confidence: 99%

Developmental anatomy of the atlas and axis in childhood by computed tomography

Piatt¹,

Grissom

2011

PED

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Object The CT modality plays a central role in the diagnosis of cervical spine fractures. In childhood, radiolucent synchondroses between ossification centers can resemble fractures, and they can be the sites of fractures as well. Recognition of cervical spine fractures in children requires familiarity with normal developmental anatomy and common variants as they appear on CT scans. Methods A convenience sample of 932 CT scans of the cervical spine accessible on the picture archiving and communications system (known as PACS) at a single children's hospital was examined. Scans were excluded from further analysis if they did not include the atlantoaxial region or were otherwise technically unsatisfactory; if the patient carried the diagnosis of a skeletal dysplasia; or if there were developmental lesions noted at other levels of the spine. No more than 1 scan per patient was analyzed. Synchondroses were graded as radiolucent, not totally radiolucent but still visible, or no longer visible. Their locations and symmetries were noted. The presence or absence of the tubercles of the transverse ligament was noted as well. Results After exclusions, 841 studies of the atlas and 835 studies of the axis were analyzed. The 3 common ossification centers of the atlas arose in the paired neural arches and the anterior arch, but in as many as 20% of cases the anterior arch developed from paired symmetrical ossification centers. The 5 common ossification centers of the axis arose in the paired neural arches, in the basal center, in the dentate center (from which most of the dentate process develops), and in the very apex of the dentate process. The appearance of each synchondrosis was noted at sequential ages. The tubercles for the transverse ligament generally did not appear until the ossification of the synchondroses of the atlas was far advanced. Anomalies of the atlas included anterior and posterior spina bifida, absence of sectors of the posterior arch, and anomalous ossification centers and synchondroses. Anomalies of the axis were much less common. What appeared possibly to be chronic, incompletely healed fractures of the atlas were discovered on review for this analysis in 6 cases. No fractures of the axis were discovered. Conclusions There is substantial variation in the time course and pattern of development of the atlas, and anomalies are common. Some fractures of the atlas may escape recognition without manifest sequelae. Variation in the time course of the development of the axis is notable as well, but anomalies seem much less common.

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Section: Elliottmentioning

confidence: 99%

Developmental anatomy of the atlas and axis in childhood by computed tomography

Piatt¹,

Grissom

2011

PED

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“…Playground slides are sometimes constructed with overhead bars from which children can swing to begin their descents; the patient in Case 1 struck the vertex of her head against such a bar. In the case described by Kapoor et al, 12 in the course of a fall on the buttocks, the inertial mass of the head was a sufficient axial load to cause a fracture in their 21-month-old patient.…”

Section: Discussionmentioning

confidence: 95%

“…14,19 However, synchondroses can also be the site of injury. 11,12,23 Atlas injury may involve the disruption of single or multiple synchondroses. Synchondrosis fractures or dislocations are difficult to appreciate radiographically and contribute to the high diagnostic error rate for cervical spine injury (24%) in young children.…”

Section: Discussionmentioning

confidence: 99%

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Jefferson fractures of the immature spine

AuYong¹,

Piatt²

2009

PED

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Jefferson fractures of the immature spine have received little attention in the study of pediatric spinal trauma. Fractures through synchondroses are a possibility in the immature spine, in addition to fractures through osseous portions of the vertebral ring, and they create opportunities for misinterpretation of diagnostic imaging. The authors describe 3 examples of Jefferson fractures in young children. All 3 cases featured fractures through an anterior synchondrosis in association with persistence of the posterior synchondrosis or a fracture of the posterior arch. The possibility of a Jefferson fracture should be considered for any child presenting with neck pain, cervical muscle spasm, or torticollis following a head injury, despite a seemingly normal cervical spine study. Jefferson fractures in young children are probably much more common than previously recognized.

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“…In several case reports, fractures were missed, resulting in delayed diagnosis and worsening symptoms. [1359] This report demonstrates how to prevent these complications and outlines a management strategy to minimize morbidity and optimize fusion rates of these fractures.…”

Section: Introductionmentioning

confidence: 99%

Isolated synchondrosis fracture of the atlas presenting as rotatory fixation of the neck: Case report and review of literature

Kobets¹,

Nakhla²,

Biswas³

et al. 2016

Surg Neurol Int

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Background:Exclusive to the pediatric population, cartilaginous fractures of the atlas are singularly rare. Rarer still are those fractures that produce a fixed, rotational deficit of the neck. Here, the authors present the case of a 4-year-old boy with an isolated fracture of the anterior synchondrosis of C1 with a rotational component following a fall, as well as a review of the literature. Management with serial bedside manipulation, which is unique to our report, helped conservatively correct the rotation of the patient's neck, and, coupled with rigid bracing, demonstrated a comprehensive management strategy that resulted in fracture ossification at 3 months.Case Description:Our patient is a 4-year-old boy who fell from a bunk bed and complained of severe neck pain. The patient was brought to the emergency room and was found to have an isolated anterior fracture of the right frontal synchondrosis of the atlas. After conservative management with a hard collar and cautious manual reductions at the bedside, rotation of our patient's neck spontaneously resolved on day 3. After 3 months of rigid immobilization, the patient remained at neurological baseline and his fracture was healed. Literature review demonstrated age range between 2 and 6 years, with a subset of patients demonstrating rotational components to their fractures. Complete resolution of nearly all patients treated with rigid immobilization after fracture was documented, yet several patients experienced delayed diagnosis.Conclusions:Knowledge of the radiographic appearance of the C1 ossification centers as well as the normal timeline and sequence of ossification is essential in differentiating a true synchondrosis fracture from normal, nonossified cervical cartilage. With early diagnosis, immobilization, pain control, and muscle relaxants, patients can recover well with conservative management, can successfully ossify fracture sites, and can recover without sequelae.

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Delayed displacement of a paediatric atlas fracture through the synchondrosis after minor trauma

Cited by 8 publications

References 3 publications

Developmental anatomy of the atlas and axis in childhood by computed tomography

Developmental anatomy of the atlas and axis in childhood by computed tomography

Jefferson fractures of the immature spine

Isolated synchondrosis fracture of the atlas presenting as rotatory fixation of the neck: Case report and review of literature

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