Fracture of the Atlas through a Synchondrosis of Anterior Arch

Cervical fractures are rare in paediatric population. In younger children, cervical fractures usually occur above the level of C4; whereas in older population, fractures or dislocations more commonly involve the lower cervical spine. Greater elasticity of intervertebral ligaments and also the spinal vertebrae explains why cervical fractures in paediatric ages are rare. The injury usually results from a symmetric or asymmetric axial loading. In paediatric cases, most fractures occur through the synchondroses which are the weakest links of the atlas. The prognosis depends on the severity of the spinal cord injury. In this case, we presented an anterior fracture in synchondrosis of atlas after falling on head treated with cervical collar. There was no neurologic deficit for the following 2 years. 1. Introduction Cervical fractures rarely occur in pediatric age group. Since the first description of an atlas fracture in 1822, there have been few reported cases. When a pediatric patient presents with persistent pain and limited movement of the neck and plain radiographs do not demonstrate an abnormality, high resolution computed tomography should be undertaken to assess for minimally displaced fractures through the anterior synchondrosis. Congenital anomalies and ossifications centers can make image interpretation very difficult. Maximum intensity projection (MIP) and volume rendered reconstructions can greatly improve diagnostic confidence. We describe a case of a fracture through the anterior synchondrosis and illustrate the contribution of reconstructed CT images to interpretation. 2. Case Report A 4-year-old girl presented to the paediatric emergency room with neck pain. She had fallen from the bunk bed onto the top of her head 3 days ago. The family described no loss of consciousness or change in mental status. There was no nausea or vomiting. The neurological examination showed no significant neurological deficit even though the patient was slightly agitated. There was a minimal decrement in the range of neck motion and cervical stiffness. The rest of the physical exam was unremarkable. Conventional standard radiographs of the cervical spine did not show evidence of a fracture. As the patient had persistent stiffness, a CT scan of the cervical spine was undertaken. Standard axial images showed slight diastasis (3.5？mm) of the right synchondrosis of anterior arch of the atlas. The relative anatomical relationships are more evident on the coronal oblique MIP and 3D volume rendered reconstructions (Figure 1). There were no signs of rotation or soft tissue