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Pediatric Trauma C-Spine X-Ray

Pediatric Trauma C-Spine X-Ray. Ashlea Wilmott PGY-1 Emergency Medicine. Objectives. Approach to the c-spine film with notable pediatric variations Ossification centre VS fracture Cases covering common pediatric injury patterns. We will not cover.

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Pediatric Trauma C-Spine X-Ray

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  1. Pediatric Trauma C-Spine X-Ray Ashlea Wilmott PGY-1 Emergency Medicine

  2. Objectives • Approach to the c-spine film with notable pediatric variations • Ossification centre VS fracture • Cases covering common pediatric injury patterns

  3. We will not cover • Non-traumatic findings (ie: epiglottitis, foreign body) • Management of fractures • Literature review of C-spine rules in children

  4. Peds C-Spine Primers • 2/3rds of pediatric spinal injuries occur in the C-Spine • Many have associated neurologic deficit • Pediatric patients injure their c-spine higher than adults

  5. Anatomical Differences that InfluenceC-Spine Injury Weak Muscles and Ligamentous Laxity Big Heads Growth plates and inherently immature bones

  6. Pediatric C-Spine < 8-10 yrs

  7. Your typical approach… With some pediatric variations… Pseudosubluxation Ossification Centres OvalContour Loss of Lordosis Soft tissue measurements Pre-dental Space Pseudospread C1

  8. dequacy

  9. lignment A- Anterior vertebral line B- Posterior vertebral line C- Spinolaminar line D- Spinous processes

  10. Loss of Lordosis Pseudosubluxation

  11. Loss of Lordosis • Distance between spines not > 1.5X adjacent • C1-2 normal up to 10-12mm

  12. Pseudosubluxation and Swischuk’s line

  13. 2mm

  14. Child on a Spine board = flexion

  15. Alignment - Odontoid Normal up to 7mm of lateral displacement

  16. Rotation = False displacement

  17. one • Oval contour and anterior wedging • Ossification centres

  18. Contour and Wedging 3mm

  19. Ossification CentresC1 7 7 3

  20. Ossification CentresC2 6 3 6

  21. Odontoid age 4 Odontoid age 8

  22. Ossification CentresC3-C7 6 6 3

  23. So many ossification centres…so little memory… • The spinous process should be fused by 2-3 years • This “wishbone” should fuse with the body by age 6 – can be later in C1 • Extra caution with C2’s late fusing centres: • Base of the dens • Top of the dens

  24. artilage

  25. ens 5 mm

  26. oft Tissue

  27. Summary • Loss of lordosis, Pseudosubuxation, C1 spread • Oval contour, Ant. Wedging, ossification centres • As in adults • Pre-dental space, Tilt • Changes with age

  28. Cases to highlight a few points…

  29. Case1 Something just doesn’t look right here…

  30. Powers Ratio A D A-B/C-D < 1 C B

  31. Case Two

  32. A normal Swischuk’s line does not equal pseudosubluxation!

  33. Case Three

  34. A lucency at the physis is not always just the physis Beware the odontoid and all it’s ossification centres

  35. Case Four The absence of a visible neural arch fracture does NOT rule out hangman’s fracture

  36. Summary • Loss of lordosis, Pseudosubuxation, C1 spread • Oval contour, Ant. Wedging, ossification centres • As in adults • Pre-dental space, Tilt • Changes with age

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