Pediatric atlas fracture: a case of fracture through a synchondrosis and review of the literature

Although uncommon, atlas fractures occur in the pediatric population. We present an illustrative case of a patient with a fracture through a synchondrosis of the atlas, and we review previous reports of pediatric first cervical vertebral fractures. The clinical and radiographic findings are described. In addition, we describe the use of magnetic resonance imaging in characterizing a pediatric atlas fracture. A 6-year-old boy who fell from a tree onto his vertex presented with neck pain, cervical muscle spasm, and head tilt. Computed tomographic and magnetic resonance imaging studies demonstrated a fracture through a left anterior synchondrosis with surrounding edema. In the literature, 10 cases of pediatric atlas fracture have been reported. Treatment of pediatric atlas fractures consists of rigid bracing such as a Minerva jacket. All of the cases of isolated C1 fracture in children, except the patient originally described by Sir Geoffrey Jefferson, survived and recovered with full function. Surgery is rarely indicated for isolated atlas fractures. The classic clinical presentation, combined with an appropriate injury scenario, should alert the clinician to the possibility of a pediatric atlas fracture and should prompt rapid evaluation with imaging studies to establish a diagnosis. When the injury is appropriately diagnosed and treated, an excellent outcome can be expected.