title: Delayed diagnosis of fractured anterior arch of the atlas in a young child.
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.
authors.affiliation: Department of Pediatric Surgery, University Children's Hospital (UKBB), Basel, Switzerland.
authors.forename: Sergio B
authors.initials: SB
authors.lastname: Sesia
authors.affiliation: Department of Paediatric Radiology, University Children's Hospital, Basel, Switzerland.
authors.forename: Friederike
authors.initials: F
authors.lastname: Prüfer
authors.affiliation: Department of Emergency, University Children's Hospital, Basel, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Walther
authors.affiliation: Department of Orthopedic and Spine Surgery, University Children's Hospital, Basel, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Studer
mesh_terms: D000058:Accidental Falls; D002370:Casts, Surgical; D001270:Cervical Atlas / Q000293:injuries*; D002675:Child, Preschool; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D005260:Female; D005592:Fracture Fixation / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging; D009069:Movement Disorders / Q000209:etiology; D064847:Multimodal Imaging; D019547:Neck Pain / Q000209:etiology; D016059:Range of Motion, Articular; D016103:Spinal Fractures / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome