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Case Reports
. 2017 Jan 10:2017:bcr2016214472.
doi: 10.1136/bcr-2016-214472.

Delayed diagnosis of fractured anterior arch of the atlas in a young child

Sergio B Sesia  1 , Friederike Prüfer  2 , Michael Walther  3 , Daniel Studer  4
Affiliations
Case Reports

Delayed diagnosis of fractured anterior arch of the atlas in a young child

Sergio B Sesia et al. BMJ Case Rep. .

Abstract

A 2-year-old girl fell off a bunk bed onto a parquet floor. She immediately reported neck pain and presented with muscle spasm and limited motion of the cervical spine (C-spine). Plain X-rays of the C-spine showed no osseous lesion. Owing to persisting pain and limited motion in the neck, MRI of the C-spine was obtained which revealed intact ligaments and cervical spinal cord, as well as soft tissue swelling in front of the anterior arch of the atlas. Subsequent CT of the C-spine confirmed a complete, undisplaced fracture of the anterior arch of the atlas (Gehweiler type I fracture). A Minerva cast was applied for 2 months, followed by a soft cervical collar. Persistent neck pain and limited range of motion of the neck after a fall may be indicative of atlas fracture that should be ruled out by CT.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Anteroposterior and lateral plain X-rays of the cervical spine.
Figure 2
Figure 2
T2-weighted sagittal MRI of the C-spine showing an oedema in the prevertebral soft tissues (red arrow).
Figure 3
Figure 3
Sagittal CT of the C-spine showing an undisplaced fracture of the right anterior arch of the atlas (red arrow).
Figure 4
Figure 4
Minerva cast (3M Scotchcast, 3M (Suisse) S.à.r.l., Rüschlikon, Switzerland).
See this image and copyright information in PMC

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