Abstract
In the acute setting, accurate radiological interpretation of paediatric cervical spine trauma can be difficult due to a combination of normal variants and presence of multiple synchondroses. We present a rare case of a fracture through the anterior atlantal synchondrosis in a paediatric spine. A five-year-old boy, who fell backwards onto the top of his head while swinging across on a monkey bar frame, presented with neck pain, cervical muscle spasm and decreased right lateral rotation and extension of his neck. Computed tomography showed a displaced diastatic fracture through right anterior atlantal synchondrosis. There are only 12 cases of paediatric C1 fractures reported in the world literature. The importance of considering this diagnosis in the appropriate clinical setting, and the normal variants in the paediatric atlas that can cause diagnostic dilemma to the interpreting radiologist, are discussed in this case report.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Hamilton MG, Myles ST. Pediatric spinal injury: review of 174 hospital admissions. J Neurosurg 1992; 77:700–704
Henrys P, Lyne ED, Lifton C, et al. Clinical review of cervical spine injuries in children. Clin Orthop 1977; 129:172–176
Jefferson G. Fracture of the atlas vertebra: Report of four cases and a review of those previously recorded. Br J Surg 1920; 7:407–411
Galindo MJ Jr, Francis WR. Atlantal fracture in a child through congenital anterior and posterior arch defects. A case report. Clin Orthop 1983; 178:220–222
Kesterson L, Benzel E, Orrison W, Coleman J. Evaluation and treatment of atlas burst fractures (Jefferson fractures). J Neurosurg 1991; 75:213–220
Marlin AE, Williams GR, Lee JF. Jefferson fractures in children. Case report. J Neurosurg 1983; 58:277–279
Mikawa Y, Watanabe R, Yamano Y, Ishii K. Fracture through a synchondrosis of the anterior arch of the atlas. J Bone Joint Surg Br 1987; 69:483
Richards PG. Stable fractures of the atlas and axis in children. J Neurol Neurosurg Psychiatry 1984; 47:781–783
Routt ML Jr, Green NE. Jefferson fracture in a 2-year-old child. J Trauma 1989; 29:1710–1712
Wirth RL, Zatz LM, Parker BR. CT detection of a Jefferson fracture in a child. AJR Am J Roentgenol 1987; 149:1001–1002
Judd DB, Liem LK, Petermann G. Pediatric atlas fracture: a case of fracture through a synchondrosis and review of the literature. Neurosurgery 2000; 46:991–994
Bayar MA, Erdem Y, Ozturk K, Buharali Z. Isolated anterior arch fracture of the atlas: child case report. Spine 2002; 27:E47–49
Sherk HH, Schut L, Lane JM. Fractures and dislocation of the cervical spine in children. Orthop Clin North Am 1976; 3:593–604
Suss RA, Zimmerman RD, Leeds NE. Pseudospread of the atlas: false sign of Jefferson fracture in young children. AJR Am J Roentgenol 1983; 140:1079–1082
Levine AM, Edwards CC. Treatment of injuries in the C1–C2 complex. Orthop Clin North Am 1986; 17:31–44
Silverman NS, Byrd SE, Fitz CR. Spine and pelvis. In: Silverman FN, Kuhn JP, Berden WE. Jefferson fracture. AJR Am J Roentgenol 1983; 140:1083–1086
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Thakar, C., Harish, S., Saifuddin, A. et al. Displaced fracture through the anterior atlantal synchondrosis. Skeletal Radiol 34, 547–549 (2005). https://doi.org/10.1007/s00256-005-0904-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-005-0904-0