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Traumatic atlanto-occipital dislocation in children

D I Bulas1, C R Fitz, D L Johnson

  • 1Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC 20010.

Radiology
|July 1, 1993
PubMed
Summary

Traumatic atlanto-occipital dislocation is a severe pediatric injury. Widened distance between the dens and basion (DB distance) on X-rays is a key indicator, even before other signs appear.

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Area of Science:

  • Pediatric Traumatology
  • Radiology
  • Neurosurgery

Background:

  • Traumatic atlanto-occipital dislocation is a rare but devastating injury in children.
  • Early identification is crucial for patient outcomes.

Purpose of the Study:

  • To evaluate radiographic criteria for diagnosing traumatic atlanto-occipital dislocation in children.
  • To correlate these findings with clinical presentation and outcomes.

Main Methods:

  • Retrospective review of 11 pediatric cases with traumatic atlanto-occipital dislocation.
  • Analysis of radiographic measurements: DB distance, BC/OA ratio, and atlanto-occipital joint width.
  • Comparison with normal pediatric values derived from 110 lateral cervical spine radiographs.

Main Results:

  • All 11 pediatric patients exhibited an increased DB distance (mean 1.7 cm) compared to normal pediatric values (8.3 mm +/- 4.2 mm).
  • The BC/OA ratio was abnormal (>1) in six patients.
  • Six children died, while five survived with minimal to no neurologic sequelae.

Conclusions:

  • Widened DB distance is a significant radiographic indicator of traumatic atlanto-occipital dislocation in children.
  • This measurement can be an early diagnostic clue, even in the absence of clear clinical signs.

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