[Traumatic occipitocervical and atlantoaxial dislocation with clivus fracture in a child. Case report]

Abstract

Background: Cranieovertebral junction lesions in the paediatric population are associated with a low survival rate, which has declined in recent years. Neurological disability is a major concern due to the high economical cost it represents. Paediatric patients are more susceptible to this lesion because of hyperextension capacity, flat articulation, and increased ligamentous laxity. Survival after these kinds of injuries has been more often reported in adults, but are limited in the paediatric population.

Clinical case: A case is reported of an 8-year-old male with occipitocervical and atlantoaxial dislocation associated with clivus fracture, brain oedema, and post-traumatic subarachnoid haemorrhage (SAH). A halo vest system was placed with no traction. One month after the trauma the patient was surgically treated with C1 and C2 trans-articular screws, occipitocervical fixation with plate and screws, and C1- C2 fixation with tricortical bone graft and wires without complication. He has now returned to school and is self-sufficient.

Conclusions: With better pre-hospital medical care and with improved surgical techniques the mortality rate has declined in this kind of lesion.

Keywords: Axis dislocation; Cervical atlas dislocation; Clivus fracture; Fractura del clivus; Hemorragia subaracnoidea postraumática; Lesión cerebral traumática; Luxación atlantoaxial; Luxación del axis; Post-traumatic subarachnoid haemorrhage; Traumatic brain injury.