Article
A rare case of extension type teardrop fracture of the cervical spine in an adolescent
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Published: | October 23, 2017 |
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Objectives: The incidence of cervical spine fractures in children and adolescents is low (1.2-1.6%). Most injuries in children below the age of 8 occur in the upper cervical spine (C0-C2). In older children or adolescents lower cervical spine injuries can occur. Concomitant spinal cord injuries are present in the majority of patients with cervical spine fractures. The main fracture mechanism in younger children is a traffic accident. Older children or adolescents fracture their cervical spine more often in sports related injuries.
Methods: A 15-year-old girl walked in the emergency department of a peripheral hospital with slight neck pain after a motorcycle accident. She reported a fall on her head. Clinical examination showed a hematoma on the forehead and pain of the upper cervical spine by palpation. The neurological examination was uneventful. There were no
concomitant injuries. Standard X-ray showed an anterior inferior fracture of the body of C2 with traumatic retrolisthesis. The neck was immediately immobilized in a stiff collar and the patient was transfered to our tertiary Trauma center by ambulance. A CT Scan and an MRI confirmed the diagnosis of an anterior avulsion fracture with a complete disruption of the intervertebral disc posterior and a rupture of the anterior longitudinal ligament. The posterior longitudinal ligament remained intact. In the light of the instability of this fracture urgent operative treatment was indicated. Open reduction and internal fixation by an anterior approach was performed. A combination of compression screws for reduction of the anterior fragment and plating of C2-C3 was performed.
Results and Conclusion: An extension type teardrop fracture of the C2 vertebra is not common, even in the adult population. Hence, no treatment recommendations are available. Literature is lacking. Operative treatment by anterior or posterior approach is mentioned only in case reports in adult patients. Some authors even treated these fractures with reduction and fixation by a Halo Fixateur.
This case report demonstrated a rare case of upper cervical spine fracture in an adolescent girl. Despite slight clinical symptoms standard radiographs were performed due to this potential high-energy injury. After confirmation of the diagnosis the cervical spine was immediately immobilized. Due to this complex injury pattern a referral in a tertiary Trauma Center of this unstable fracture is inevitable.