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Avulsion transverse ligament injuries in children: successful treatment with nonoperative management. Report of three cases

Neck injuries in children most commonly affect the upper cervical spine. Injuries of the transverse ligament and its attachments may result in C1-2 instability, but the optimum form of treatment is unknown. Three patients, who ranged in age from 5 to 11 years, sustained transverse atlantal ligament injuries with unilateral avulsion fracture of the osseous tubercle of C-1. One child was injured in a fall and two were involved in motor vehicle accidents. Although all patients presented with neck pain, none exhibited neurological deficits. Plain radiography demonstrated no evidence of osseous injury, but an increased predental interval was noted in each case. Computerized tomography (CT) scanning demonstrated the avulsion fractures, and magnetic resonance imaging revealed evidence of soft-tissue injuries in the occipital-C2 ligamentous complex. All children were managed with external immobilization (halo vest in two and a Sterno-Occipito-Mandibular Immobilizer brace in one), for 6 to 12 weeks. Follow-up CT scanning demonstrated reattachment of the avulsed osseous tubercle, and dynamic cervical spine radiographs revealed the absence of C1-2 instability. The results of these cases suggest a role for external immobilization in the treatment of osseous avulsion injuries of the transverse atlantal ligament in children

Keywords : Accidents,Cervical Vertebrae,Child,Child,Preschool,diagnostic imaging,External Fixators,Female,Fracture Fixation,Humans,Immobilization,injuries,Ligaments,Magnetic Resonance Imaging,Male,Neck,Neck Injuries,Neck Pain,Neurosurgery,Pain,Patients,physiopathology,Radiography,Spinal Fractures,Spine,therapy,Treatment Outcome,, Transverse,Ligament,Injuries,Children, lower back pain x ray or mri

Date of Publication : 2002 Apr

Authors : Lo PA;Drake JM;Hedden D;Narotam P;Dirks PB;

Organisation : Division of Neurosurgery, Royal Children’s Hospital, Melbourne, Australia

Journal of Publication : J Neurosurg

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/11990844

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