C1-C2 Fracture-Dislocations in Children and Adolescents

Lui, Tai Ngar; Lee, Shih Tseng; Wong, Cheuk Wah; Yeh, Yung‐Sung; Tzaan, Wen-Ching; Chen, Tzu Yung; Hung, Shang Yu

doi:10.1097/00005373-199603000-00014

Cited by 35 publications

(27 citation statements)

References 14 publications

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“…Among the various C1-2 internal fixation techniques, the nonunion rate ranges from 4 to 50% [8, 9, 13, 14, 25, 30, 31, 32]. Factors contributing to nonunion include wide C1-2 range of motion, abnormal translation in presence of pathological C1-2 abnormalities (particularly in children), and C1-2 motion inside the halo, which can result in rapid absorption of the bone graft [7].…”

Section: Discussionmentioning

confidence: 99%

Pediatric Atlantoaxial Instability: Management with Screw Fixation

Wang¹,

Vokshoor²,

Stanley³

et al. 1999

Pediatr Neurosurg

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Sixteen pediatric patients (age range 3–15 years; mean 9.4 years) with atlantoaxial instability underwent screw fixation at Columbus Children’s Hospital between 1992 and 1998. Three patients with type II odontoid fractures underwent odontoid screw fixation. The remaining group of 13 patients had posterior C1-2 transarticular screw fixation and Sonntag C1-2 fusion. The group included 3 patients with rotatory C1-2 fixation, 4 patients with os odontoideum, 4 patients with congenital atlantoaxial instability and 2 patients with traumatic C1-2 instability. Postoperatively, all patients were placed in a Miami-J collar only. At 3 months follow-up, all patients achieved fusion. Bony fusion across the fracture line was clearly evident in patients with odontoid screws. The only complications in this series were a transient swallowing difficulty that resolved spontaneously in 2 weeks, and another patient’s C1-2 fusion had extended to C2-3 at 9 months follow-up. This study demonstrates that children at 3 years of age and older, who sustain a type II odontoid fracture with an intact transverse ligament, can be safely managed with odontoid screws if the fracture is less than 4 weeks old. Posterior C1-2 transarticular screw fixation can be done safely and results in a high fusion rate in children older than 4 years of age. The technical difficulties of screw fixation in children are discussed.

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Section: Discussionmentioning

confidence: 99%

Pediatric Atlantoaxial Instability: Management with Screw Fixation

Wang¹,

Vokshoor²,

Stanley³

et al. 1999

Pediatr Neurosurg

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“…High cervical injuries are uncommon in the pediatric population and are commonly associated with high-energy mechanisms, such as motor vehicle accidents and pedestrians struck by automobiles [2][3][4]. Fractures of C2 are more likely to happen in younger children (age <8).…”

Section: Pediatric Fractures Of the Atlasmentioning

confidence: 99%

Fractures of the axis: a review of pediatric, adult, and geriatric injuries

Gornet

Kelly

2016

Curr Rev Musculoskelet Med

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Fractures of the second cervical vertebra (C2, axis) are common in adult spine surgery. Those fractures occurring in younger adult patients are often associated with highenergy mechanism trauma, resulting in a "Hangman's Fracture." Management of these fractures is often successful with nonoperative means, though surgery may be needed in those fractures with greater displacement and injury to the C2-C3 disc. Older patients are more likely to sustain fractures of the odontoid process. The evidence supporting surgical management of these fractures is evolving, as there may be a mortality benefit to surgery. Regardless of treatment, longerterm mortality rates are high in this patient population, which should be discussed with the patient and family at the time of injury. Pediatric patients may suffer fractures of the axis, though differentiation of normal and pathologic findings is necessary and more difficult with the skeletally immature spine.

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“…Rotatory atlantoaxial subluxation is common in children after minor injuries [9], as a manifestation of Grisel's syndrome [15], or after severe trauma (e.g., due to a motor vehicle accident) [22]. It is rare in adults.…”

Section: Discussionmentioning

confidence: 99%

“…The choice between conservative treatment and C2-C1 fusion is directly de- pendent on whether or not the transverse ligament is torn or avulsed [8,16]. C2-C1 instability due to severe trauma requires fusion and, if neurological compromise is present, spinal cord decompression [13,22].…”

Section: Discussionmentioning

confidence: 99%