Synchondrosis fracture in a pediatric patient.

A 6-year-old boy arrived at the emergency department three days after falling 51/2 metres (19 feet) from a balcony. Bystanders said that the child appeared to have landed on his forehead. The child complained of neck pain and held his head stiffly. On examination, his C-spine movements were decreased and he held his head tilted to the left. The rest of the physical exam, including a neurological examination, was unremarkable. Extensive soft tissue swelling anteriorly and a widened atlanto-dental interval was seen on plain radiographs. Computed tomography revealed fractures through the synchondroses of the anterior arch of C1. The central portion of the C1 vertebra was displaced anteriorly by 6 mm on the left side and 1 mm on the right (Fig. 1, left scan). The patient was immobilized with a halo vest, and CT repeated under general anesthesia. With the boy in the CT scanner, reduction was achieved with digital compression applied transorally by the staff surgeon (Fig. 1, middle). A follow-up CT scan demonstrated closure of the synchondrosis and maintenance of the reduction (Fig. 1, right). The child quickly returned to normal activities, with no further symptoms. Three years later his radiographs are normal, with no evidence of stenosis or C1 arch hypoplasia. Discussion