Pediatric Atlas Fracture: A Case of Fracture through a Synchondrosis and Review of the Literature

Abstract

The classic clinical presentation, combined with an appropriate injury scenario, should alert the clinician to the possibility of a pediatric atlas fracture and should prompt rapid evaluation with imaging studies to establish a diagnosis. When the injury is appropriately diagnosed and treated, an excellent outcome can be expected.

Delayed diagnosis of fractured anterior arch of the atlas in a young child

“…Our patient did not demonstrate any prevertebral soft tissue swelling, an indirect sign of a fracture of the C-spine, on plain X-ray images 24. Therefore, we decided to perform an MRI of the C-spine in accordance with the suggestion of Judd et al 25 to further assess the integrity of the atlantal ligament. Although this did not confirm the spine fracture, MRI verified the integrity of ligaments, ruled out congenital malformations and helped to detect prevertebral haematoma.…”

Jefferson Fracture in a Child – Illustrative Case Report

“…Clinical symptoms range from being asymptomatic, neck pain, cervical muscle spasm, decreased range of neck motion to head tilt [4,10,11,12,13]. Neurological deficits or even fatal symptoms, as described by Jefferson [15] or encountered in cases of unstable, complex atlantoaxial injuries, are unlikely in isolated atlas fractures in children [5].…”

“…MRI shows the fractures, additional fluid collections in the predental and intraspinal spaces, and spinal cord injury as well as the integrity of the transverse atlantal ligament, and helps to assess the surrounding soft tissue [6]. A CT scan shows the arch fractures in more detail, excludes normal variants, congenital arch malformations [9, 14] and synchondrosis fractures [12, 13], and is helpful to document the healing during the following months. In this rare case of a Jefferson fracture in a child strictly monitored by means of radiological imaging techniques, important aspects of conservatively treated atlas burst fractures are illustrated.…”

“…However, in the pediatric population, isolated atlas burst fractures, also known as Jefferson fractures, are extremely rare [5, 6], and only few cases have been reported so far [7,8,9,10,11]. They have to be distinguished from synchondrosis fractures in children [12, 13] and from normal variants as well as congenital arch malformations [2, 13, 14]. Apart from 1 case of a 3-year-old boy who died, which was described by Sir Geoffrey Jefferson in 1920 [15], all other published cases showed a highly consistent clinical presentation with rare neurological deficits.…”

“…Apart from 1 case of a 3-year-old boy who died, which was described by Sir Geoffrey Jefferson in 1920 [15], all other published cases showed a highly consistent clinical presentation with rare neurological deficits. Furthermore, in children the signs of atlas fractures might be very subtle, like neck pain, decreased range of neck motion and head tilt, and therefore these fractures may easily be overlooked [12, 13]. The classic clinical presentation, combined with an appropriate injury scenario (mostly falls on the head and motor cycle accidents leading to an axial compression load), should alert the clinician to the possibility of an atlas fracture and should prompt suitable evaluation and imaging studies [5, 6, 13].…”