title: Transverse ligament rupture and atlanto-axial subluxation in children.
abstract: We report four children aged two to nine years with traumatic tears of the transverse ligament of the atlas and atlanto-axial subluxation. This is extremely rare in this age group since trauma usually causes a skeletal rather than a ligamentous injury. The injuries resulted from falls or motor vehicle accidents, with considerable delay in diagnosis. Flexion radiographs showed atlas-dens intervals (ADI) of 6, 7, 8 and 13 mm; all four patients were treated by posterior fusion at C1-C2 after the failure of conservative treatment. In one child with quadriparesis and a fixed ADI of 13 mm, transoral anterior resection of the odontoid was performed before the fusion. Diagnosis of this traumatic lesion requires a high level of suspicion. Conservative treatment is likely to fail; surgical stabilisation is indicated.
authors.affiliation: Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Floman
authors.forename: L
authors.initials: L
authors.lastname: Kaplan
authors.forename: J
authors.initials: J
authors.lastname: Elidan
authors.forename: F
authors.initials: F
authors.lastname: Umansky
mesh_terms: D001268:Atlanto-Axial Joint / Q000293:injuries*; D016025:Bone Transplantation; D001864:Bone Wires; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D008023:Ligaments, Articular / Q000293:injuries*; D016059:Range of Motion, Articular; D012421:Rupture; D013123:Spinal Fusion; D014057:Tomography, X-Ray Computed