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Traumatic atlanto-occipital dislocation in children.

Harish S Hosalkar1, Eric L Cain, David Horn

  • 1Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Wood Building, 2nd Floor, Philadelphia, PA 19104, USA.

The Journal of Bone and Joint Surgery. American Volume
|November 3, 2005
PubMed
Summary

Traumatic atlanto-occipital dislocation in children is rare but survivable with modern care. Prompt diagnosis, intubation, immobilization, and steroids improve outcomes for these severe pediatric injuries.

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Area of Science:

  • Pediatric Traumatology
  • Neurosurgery
  • Orthopedic Surgery

Background:

  • Traumatic atlanto-occipital dislocation is a rare, often fatal injury in children and adolescents.
  • Modern prehospital care has increased survival rates for this injury.
  • Early intervention can lead to satisfactory neurologic function.

Purpose of the Study:

  • To analyze outcomes of traumatic atlanto-occipital dislocation in pediatric patients treated with modern resuscitation.
  • To identify factors influencing survival and functional outcomes.

Main Methods:

  • Retrospective review of sixteen pediatric cases (1986-2003) of atlanto-occipital dislocation.
  • Analysis of trauma registry data, medical charts, and radiographs.
  • Neurological evaluation of survivors at long-term follow-up.

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Main Results:

  • Mean age was 7.6 years; diverse injury mechanisms.
  • Eight of sixteen patients died on arrival; eight survived initially.
  • Survivors received immobilization and steroids; three died during surgery.
  • Long-term follow-up showed one normal, three with mild hemiparesis, one with quadriplegia.

Conclusions:

  • Prompt recognition and treatment improve survival in pediatric atlanto-occipital dislocation.
  • Early diagnosis, intubation, immobilization, and steroids are key facilitators.
  • Occiput-C2 arthrodesis is recommended for survivors, especially with incomplete spinal cord injury.