Paediatric Spinal Trauma & Fractures
Paediatric Occiput - C1 Spinal lesions
- these are rare & rarely survived
- decelleration injury leading to dislocation with hyperflexion
- beaware of SOB, cranial nerve dysfunction & motor dysfunction
- do not overdistract the patient
- Powers ratio
- Powers ratio
- is determined by drawing a line from the basion (B) to the posterior arch of the atlas (C) & a second line from the opisthion (O) to the anterior arch of the atlas (A).The length of line BC is divided by the length of line Osteoarthritis
- A ratio greater than 1.0 is diagnostic of anterior atlantooccipital translation, & a ratio less than 0.55 is diagnostic of posterior translation.
Treatment
- In children who are younger the posterior elements are generally not well formed at C1, hence we fuse occiput –C3
- In adolescent they use a triple wire technique one through the occiput, one sublaminar at the atlas & one through the spinous process of C2 & these are tied down over iliac crest bonegrafts
- Post operative treatment includes halo immobilization
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