title: Traumatic atlanto-occipital dislocation in children.
abstract: Traumatic atlanto-occipital dislocation is seen in approximately 25% of fatal pediatric trauma. This was previously considered to be a rare and fatal entity, however with improvements in resuscitation in the field, many patients who previously might have died are now evaluated in the hospital. Treatment of atlanto-occipital instability is internal fixation. Many authors have advocated supplemental external immobilization with a halo vest. However, there are several circumstances where the application of a halo vest is undesirable. Thus a method of internal fixation and fusion that is rigid enough not to require supplemental external orthosis is necessary. We present 2 cases of atlanto-occipital dislocation which were treated with Locksley intersegmental tie bar occipital cervical fusion. Both patients achieved solid fusion without supplemental halo bracing, and made complete neurologic recoveries. Traumatic atlanto-occipital dislocation is a potentially survivable injury that requires aggressive resuscitation in the field, a high index of suspicion and early definitive surgical stabilization.
authors.affiliation: Section of Neurosurgery, Medical College of Georgia, Augusta, Ga. 30912, USA. phoule@mail.mcg.edu
authors.forename: P
authors.initials: P
authors.lastname: Houle
authors.forename: D E
authors.initials: DE
authors.lastname: McDonnell
authors.forename: J
authors.initials: J
authors.lastname: Vender
mesh_terms: D000293:Adolescent; D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D009985:Orthopedics; D011859:Radiography; D012720:Severity of Illness Index