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Management of a 9-Month-Old Infant with Traumatic Atlanto-occipital Dislocation and Atlantoaxial Instability: A Case
Shannon Tse1, Dagoberto Piña1, Lauren A Hisatomi2
1Department of Orthopaedic Surgery, University of California Davis, Sacramento, California.
Insights
This case study highlights a rare pediatric injury: traumatic atlanto-occipital dislocation (AOD) in a 9-month-old. Occipitocervical fusion proved effective for this high-energy trauma in a young child.
Area of Science:
- Pediatric Traumatology
- Neurosurgery
- Orthopedic Surgery
Background:
- Traumatic atlanto-occipital dislocation (AOD) is a rare but severe injury, predominantly affecting children after high-energy incidents.
- Atlanto-occipital dislocation (AOD) involves disruption of the occipital bone and the first cervical vertebra (C1).
Purpose of the Study:
- To report a case of traumatic atlanto-occipital dislocation (AOD) in a 9-month-old infant.
- To emphasize the importance of early diagnosis and prompt intervention for pediatric AOD.
- To evaluate the efficacy and safety of occipitocervical fusion in young children with AOD.
Main Methods:
- A 9-month-old female sustained AOD, atlantoaxial instability, and a C2 synchondrosis fracture after a motor vehicle collision.
- Initial management involved a halothoracic vest for damage control, which failed to maintain reduction.
- Definitive treatment consisted of posterior occipitocervical fusion.
Main Results:
- The initial conservative management with a halothoracic vest was insufficient to stabilize the injury.
- Posterior occipitocervical fusion was successfully performed, achieving stable reduction.
- The patient experienced successful postoperative outcomes, demonstrating the viability of this surgical approach in infants.
Conclusions:
- Traumatic atlanto-occipital dislocation (AOD) is a critical pediatric injury requiring urgent management.
- Timely diagnosis and surgical intervention, such as occipitocervical fusion, are crucial for favorable outcomes in pediatric patients.
- Occipitocervical fusion is a safe and effective treatment for traumatic AOD in infants, even with anatomical challenges, when planned meticulously.
Case:
We report a 9-month-old girl who was involved in a motor vehicle collision and sustained atlanto-occipital dislocation (AOD), atlantoaxial instability, and a C2 synchondrosis fracture. Initial management with a halothoracic vest for damage control failed to maintain reduction, necessitating definitive posterior occipitocervical fusion.
Conclusion:
Traumatic AOD is a rare injury, most common in children following high-energy trauma. Early diagnosis and timely intervention are imperative for improved clinical outcomes. Even in young patients with small anatomy, with careful preoperative planning, occipitocervical fusion is effective and safe with successful postoperative outcomes.
