C1-C2 fracture-dislocations in children and adolescents

Tai Ngar Lui, Shih Tseng Lee, Cheuk Wah Wong, Yi Shian Yeh, Wen Ching Tzaan, Tzu Yung Chen, Shang Yu Hung

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective: C1-C2 is the predominant level of cervical spine injuries in children and adolescents. Either a fracture of the dens or atlantoaxial dislocation (AAD) without fracture of the dens can occur. We present a number of cases to compare their clinical presentations and discuss the preferred method of treatment. Material and Methods: There were 12 cases of type II odontoid fracture and 10 cases of AAD without fracture over a 13-year period. There was a male predominance and traffic collisions were the major cause of injury. Two thirds of the dens fractures were in children over 13 years of age and seven out of ten dislocations without fracture were under 13 years of age. Eight patients with fractured dens suffered from spinal cord injuries but six of those with dislocations were neurologically intact. Two patients of fractured dens and one with AAD presented with chronic myelopathies because of undetected injuries. Results: Three patients expired because of irreversible respiratory failure. Most of the fractured dens achieved bony union after 3 months of halo-vest immobilization but those patients with AAD without fracture usually needed a fusion procedure. Transoral decompression was performed in two cases of dens fracture malunion. All of the survivors of the dens fracture returned to normal or independent daily living. Six of the AAD patients returned to normal, one had a mild neural deficit, and one had persistent spastic quadriparesis. Conclusions: There is a higher incidence of atlantoaxial dislocation without fracture in children under 13 years of age and a higher incidence of dens fractures in those over 13 years of age. Those with fractures of the dens are more likely to present with evidence of neural injury while those with AAD are more like to be neurologically intact; however, a correct diagnosis and proper management are mandatory to prevent chronic myelopathy. Halo-vest immobilization is sufficient for most fractures of the dens in children, with AAD usually requiring a fusion.

Original languageEnglish
Pages (from-to)408-411
Number of pages4
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume40
Issue number3
DOIs
Publication statusPublished - Mar 1996
Externally publishedYes

Fingerprint

Spinal Cord Diseases
Wounds and Injuries
Immobilization
Malunited Fractures
Independent Living
Quadriplegia
Muscle Spasticity
Incidence
Decompression
Spinal Cord Injuries
Respiratory Insufficiency
Survivors
Spine
Fracture Dislocation
Therapeutics

Keywords

  • Atlantoaxial dislocation
  • Dens fracture
  • Halo vest
  • Posterior fusion
  • Transoral decompression

ASJC Scopus subject areas

  • Surgery

Cite this

Lui, T. N., Lee, S. T., Wong, C. W., Yeh, Y. S., Tzaan, W. C., Chen, T. Y., & Hung, S. Y. (1996). C1-C2 fracture-dislocations in children and adolescents. Journal of Trauma - Injury, Infection and Critical Care, 40(3), 408-411. https://doi.org/10.1097/00005373-199603000-00014

C1-C2 fracture-dislocations in children and adolescents. / Lui, Tai Ngar; Lee, Shih Tseng; Wong, Cheuk Wah; Yeh, Yi Shian; Tzaan, Wen Ching; Chen, Tzu Yung; Hung, Shang Yu.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 40, No. 3, 03.1996, p. 408-411.

Research output: Contribution to journalArticle

Lui, TN, Lee, ST, Wong, CW, Yeh, YS, Tzaan, WC, Chen, TY & Hung, SY 1996, 'C1-C2 fracture-dislocations in children and adolescents', Journal of Trauma - Injury, Infection and Critical Care, vol. 40, no. 3, pp. 408-411. https://doi.org/10.1097/00005373-199603000-00014
Lui, Tai Ngar ; Lee, Shih Tseng ; Wong, Cheuk Wah ; Yeh, Yi Shian ; Tzaan, Wen Ching ; Chen, Tzu Yung ; Hung, Shang Yu. / C1-C2 fracture-dislocations in children and adolescents. In: Journal of Trauma - Injury, Infection and Critical Care. 1996 ; Vol. 40, No. 3. pp. 408-411.
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abstract = "Objective: C1-C2 is the predominant level of cervical spine injuries in children and adolescents. Either a fracture of the dens or atlantoaxial dislocation (AAD) without fracture of the dens can occur. We present a number of cases to compare their clinical presentations and discuss the preferred method of treatment. Material and Methods: There were 12 cases of type II odontoid fracture and 10 cases of AAD without fracture over a 13-year period. There was a male predominance and traffic collisions were the major cause of injury. Two thirds of the dens fractures were in children over 13 years of age and seven out of ten dislocations without fracture were under 13 years of age. Eight patients with fractured dens suffered from spinal cord injuries but six of those with dislocations were neurologically intact. Two patients of fractured dens and one with AAD presented with chronic myelopathies because of undetected injuries. Results: Three patients expired because of irreversible respiratory failure. Most of the fractured dens achieved bony union after 3 months of halo-vest immobilization but those patients with AAD without fracture usually needed a fusion procedure. Transoral decompression was performed in two cases of dens fracture malunion. All of the survivors of the dens fracture returned to normal or independent daily living. Six of the AAD patients returned to normal, one had a mild neural deficit, and one had persistent spastic quadriparesis. Conclusions: There is a higher incidence of atlantoaxial dislocation without fracture in children under 13 years of age and a higher incidence of dens fractures in those over 13 years of age. Those with fractures of the dens are more likely to present with evidence of neural injury while those with AAD are more like to be neurologically intact; however, a correct diagnosis and proper management are mandatory to prevent chronic myelopathy. Halo-vest immobilization is sufficient for most fractures of the dens in children, with AAD usually requiring a fusion.",
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AB - Objective: C1-C2 is the predominant level of cervical spine injuries in children and adolescents. Either a fracture of the dens or atlantoaxial dislocation (AAD) without fracture of the dens can occur. We present a number of cases to compare their clinical presentations and discuss the preferred method of treatment. Material and Methods: There were 12 cases of type II odontoid fracture and 10 cases of AAD without fracture over a 13-year period. There was a male predominance and traffic collisions were the major cause of injury. Two thirds of the dens fractures were in children over 13 years of age and seven out of ten dislocations without fracture were under 13 years of age. Eight patients with fractured dens suffered from spinal cord injuries but six of those with dislocations were neurologically intact. Two patients of fractured dens and one with AAD presented with chronic myelopathies because of undetected injuries. Results: Three patients expired because of irreversible respiratory failure. Most of the fractured dens achieved bony union after 3 months of halo-vest immobilization but those patients with AAD without fracture usually needed a fusion procedure. Transoral decompression was performed in two cases of dens fracture malunion. All of the survivors of the dens fracture returned to normal or independent daily living. Six of the AAD patients returned to normal, one had a mild neural deficit, and one had persistent spastic quadriparesis. Conclusions: There is a higher incidence of atlantoaxial dislocation without fracture in children under 13 years of age and a higher incidence of dens fractures in those over 13 years of age. Those with fractures of the dens are more likely to present with evidence of neural injury while those with AAD are more like to be neurologically intact; however, a correct diagnosis and proper management are mandatory to prevent chronic myelopathy. Halo-vest immobilization is sufficient for most fractures of the dens in children, with AAD usually requiring a fusion.

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