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CERVICAL SPINE INJURY: PEDIATRICS

CERVICAL SPINE INJURY: PEDIATRICS. LEONARD E. SWISCHUK, M.D. THE UNIVERSITY OF TEXAS MEDICAL BRANCH GALVESTON, TX. CHILDHOOD INJURIES LESS COMMON THAN IN ADULTS. MORE INJURIES OCCUR IN THE UPPER CERVICAL SPINE IN INFANTS AND YOUNG CHILDREN. WHY ?. APEX OF THE FLEXION CURVE IN UPPER SPINE.

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CERVICAL SPINE INJURY: PEDIATRICS

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  1. CERVICAL SPINE INJURY:PEDIATRICS LEONARD E. SWISCHUK, M.D. THE UNIVERSITY OF TEXAS MEDICAL BRANCH GALVESTON, TX

  2. CHILDHOOD INJURIES LESS COMMON THAN IN ADULTS

  3. MORE INJURIES OCCUR IN THE UPPER CERVICAL SPINE IN INFANTS AND YOUNG CHILDREN

  4. WHY ?

  5. APEX OF THE FLEXION CURVEIN UPPER SPINE

  6. DIVIDE PATIENTS BY AGE GROUP • 0 to 5 • 6 to 10 • 11 and over

  7. PREVERTEBRAL SOFT TISSUES • Buckling and pseudothickening • Full inspiration-extension • Pharyngeal-tracheal stepoff • Don’t spend too much time

  8. OTHER PROBLEMS • Infant and children are hypermobile • Physiologic motion may be pronounced • Immature spine • Synchondroses, etc.

  9. DENS FRACTURES • Occur through dens body synchondrosis in infants • In infants, not the same as in adults • Fragmented os terminale, pseudo fracture • Os odontoideum pseudo fracture

  10. DENS FX ANTERIOR

  11. OS TERMINALE

  12. FRAGMENTED OS TERMIONALE NORMAL

  13. FRAGMENTED OS TERMINALE NORMAL

  14. PSEUDO FX OS ODNTOIDEUM

  15. HANGMAN FRACTURES • These occur in infants • Heavy head is the mechanism • Differentiate from congenital defects

  16. CONGENITAL DEFECT

  17. C2 SYNCHONDROSES(PSEDUOFRACTURES) • Dens-body • Dens-neural arch • Oblique view • CT-parasagittal view • Aberrant synchondroses

  18. FLEXION – ROTATION INJURIES • Same as in adults • Usually mid cervical spine • Usually older children

  19. FX WEDGING ANT HYPERFLEX

  20. NORMAL ANTERIOR WEDGING • C3, C4

  21. WEDGING NORMAL C3 C4

  22. WEDGING NORMAL C3

  23. ANTERIOR SUBLUXATION(Physiologic) • C2-C3 (mostly) • C3-C4

  24. ANT SUBLUX C2-C3 PHYSIOLOGIC

  25. HYPEREXTENSION INJURIES • Same and in adults • Not as common as in adults

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