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Pediatric traumatic atlanto-occipital dislocation: five cases and a review
K Kenter1, G Worley, T Griffin
1Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA. kenterk@health.missouri.edu
Journal of Pediatric Orthopedics
|August 25, 2001
Summary
Traumatic atlanto-occipital dislocation (AOD) is survivable in children, though diagnosis can be challenging. Early, detailed radiograph measurements are crucial for identifying this severe pediatric neck injury.
Area of Science:
- Pediatric Traumatology
- Orthopedic Surgery
- Radiology
Background:
- Traumatic atlanto-occipital dislocation (AOD) is historically considered a rare and fatal injury.
- Recent reports indicate increased survival rates, particularly in pediatric cases.
- This study focuses on the diagnosis and outcomes of traumatic AOD in children.
Purpose of the Study:
- To review clinical presentations, radiologic findings, and outcomes of traumatic AOD in children.
- To evaluate diagnostic methods for AOD in pediatric patients.
- To emphasize the importance of specific radiographic measurements for early AOD detection.
Main Methods:
- Retrospective review of five pediatric traumatic AOD cases from 1985 to 1995.
- Analysis of clinical data, initial radiologic findings, and patient outcomes.
- Measurement of dens basion distance and Powers ratio on lateral cervical spine radiographs.
Main Results:
- Average dens basion distance was 9.8 mm; average Powers ratio was 1.38.
- Three of five children survived, two with associated spinal cord injuries.
- Three cases were initially undiagnosed, highlighting diagnostic difficulties.
Conclusions:
- Traumatic atlanto-occipital dislocation in children can be survivable.
- Diagnosis via standard lateral cervical spine radiographs can be challenging.
- Detailed radiographic measurements are recommended for pediatric patients at risk for AOD.