The Spine Journal
-
(2013)
-
Type III dens fracture with vertical distraction A 10-year-old boy was involved in a high-speed motor vehicle collision. At the scene of the accident, he was awake and complaining of neck pain. The boy was placed in a Philadelphia collar and transferred to our hospital. On admission, general physical and neurologic examinations were normal. Cervical spine radiograph and computed tomographic scan demonstrated a displaced type III dens fracture (Figs. 1 and 2). The patient was treated with skeletal skull traction (1.5 kg). One hour after traction, the patient felt progressive limb anesthesia and dyspneic respiration. The saturation of blood oxygen was only 85%. Immediately, the skull traction was discontinued and the patient underwent
Fig. 1. A lateral radiograph of the cervical spine showing a displaced type III dens fracture. 1529-9430/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2013.09.015
Fig. 2. Computed tomographic scan of the cervical spine showing a displaced type III dens fracture.
Fig. 3. New lateral radiograph of the cervical spine showing a dens fracture with vertical displacement.
2
Y.S. Wu et al. / The Spine Journal
Fig. 4. Postoperative lateral cervical radiograph showing C1–C2 arthrodesis with C1 lateral mass–C2 pedicle screw fixation.
tracheal intubation. A new cervical spine radiograph revealed a vertical atlantoaxial distraction (Fig. 3). Two hours later, the symptoms of limbs anesthesia and dyspneic respiration disappeared. Blood oxygen saturated returned to 95%. The patient underwent a C1–C2 arthrodesis with C1 lateral mass–C2 pedicle screw fixation 2 days after admission. Postoperative radiographs demonstrated that anatomic reduction and rigid fixation was achieved (Fig. 4). Cervical magnetic resonance imaging examination revealed no spinal cord injury (Fig. 5). All functions had recovered to normal at the 2-month follow-up examination. Skull traction is an effective standard method of reducing dislocation or immobilizing unstable injury in acute cervical spine trauma until surgical stabilization can be performed [1]. Usually, the force of traction used in adults is 2kg for the head and 0.5 kg for each vertebra [2]. Young children, however, have relatively weak ligamentous and muscular structures, gentle traction could cause a severe distraction injury, especially in an unstable cervical spine fracture. To avoid serious complications, the force of traction should keep low, and radiological and neurologic observation should be maintained throughout the procedure. References [1] Lauweryns P. Role of conservative treatment of cervical spine injuries. Eur Spine J 2010;19:S23–6.
-
(2013)
-
Fig. 5. Postoperative sagittal T2-weighted magnetic resonance image showing no spinal cord injury. [2] Jeanneret B, Magerl F, Ward JC. Overdistraction: a hazard of skull traction in the management of acute injuries of the cervical spine. Arch Orthop Trauma Surg 1991;110:242–5.
Yao S. Wu, MDa,b Lin W. Chen, MDa Nai F. Tian, MDb Zhi J. Pan, MDa Yan Lin, MDb a Department of Orthopaedic Surgery Second Affiliated Hospital School of Medicine, Zhejiang University 88 Jiefang Road Hangzhou, China b Department of Orthopaedic Surgery Second Affiliated Hospital of Wenzhou Medical College 109 Xueyuan Xi Road Wenzhou, China FDA device/drug status: Not applicable. Author disclosures: YSW: Nothing to disclose. LWC: Nothing to disclose. NFT: Nothing to disclose. ZJP: Nothing to disclose. YL: Nothing to disclose. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
-
(2013)
-
Type III dens fracture with vertical distraction A 10-year-old boy was involved in a high-speed motor vehicle collision. At the scene of the accident, he was awake and complaining of neck pain. The boy was placed in a Philadelphia collar and transferred to our hospital. On admission, general physical and neurologic examinations were normal. Cervical spine radiograph and computed tomographic scan demonstrated a displaced type III dens fracture (Figs. 1 and 2). The patient was treated with skeletal skull traction (1.5 kg). One hour after traction, the patient felt progressive limb anesthesia and dyspneic respiration. The saturation of blood oxygen was only 85%. Immediately, the skull traction was discontinued and the patient underwent
Fig. 1. A lateral radiograph of the cervical spine showing a displaced type III dens fracture. 1529-9430/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2013.09.015
Fig. 2. Computed tomographic scan of the cervical spine showing a displaced type III dens fracture.
Fig. 3. New lateral radiograph of the cervical spine showing a dens fracture with vertical displacement.
2
Y.S. Wu et al. / The Spine Journal
Fig. 4. Postoperative lateral cervical radiograph showing C1–C2 arthrodesis with C1 lateral mass–C2 pedicle screw fixation.
tracheal intubation. A new cervical spine radiograph revealed a vertical atlantoaxial distraction (Fig. 3). Two hours later, the symptoms of limbs anesthesia and dyspneic respiration disappeared. Blood oxygen saturated returned to 95%. The patient underwent a C1–C2 arthrodesis with C1 lateral mass–C2 pedicle screw fixation 2 days after admission. Postoperative radiographs demonstrated that anatomic reduction and rigid fixation was achieved (Fig. 4). Cervical magnetic resonance imaging examination revealed no spinal cord injury (Fig. 5). All functions had recovered to normal at the 2-month follow-up examination. Skull traction is an effective standard method of reducing dislocation or immobilizing unstable injury in acute cervical spine trauma until surgical stabilization can be performed [1]. Usually, the force of traction used in adults is 2kg for the head and 0.5 kg for each vertebra [2]. Young children, however, have relatively weak ligamentous and muscular structures, gentle traction could cause a severe distraction injury, especially in an unstable cervical spine fracture. To avoid serious complications, the force of traction should keep low, and radiological and neurologic observation should be maintained throughout the procedure. References [1] Lauweryns P. Role of conservative treatment of cervical spine injuries. Eur Spine J 2010;19:S23–6.
-
(2013)
-
Fig. 5. Postoperative sagittal T2-weighted magnetic resonance image showing no spinal cord injury. [2] Jeanneret B, Magerl F, Ward JC. Overdistraction: a hazard of skull traction in the management of acute injuries of the cervical spine. Arch Orthop Trauma Surg 1991;110:242–5.
Yao S. Wu, MDa,b Lin W. Chen, MDa Nai F. Tian, MDb Zhi J. Pan, MDa Yan Lin, MDb a Department of Orthopaedic Surgery Second Affiliated Hospital School of Medicine, Zhejiang University 88 Jiefang Road Hangzhou, China b Department of Orthopaedic Surgery Second Affiliated Hospital of Wenzhou Medical College 109 Xueyuan Xi Road Wenzhou, China FDA device/drug status: Not applicable. Author disclosures: YSW: Nothing to disclose. LWC: Nothing to disclose. NFT: Nothing to disclose. ZJP: Nothing to disclose. YL: Nothing to disclose. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
