Resolved question:
My 12 year old fractured her C1 left lamina and anterior arch 5 months ago falling head first from a fence. Treated with a soft collar. Recent CT scan showed left lamina fully healed, The anterior arch has not healed at all and radiologist tells us there is no sign of bone growth or fibrous growth. It was broken vertically right in the middle. No ligament damage. Considered stable and in alignment. We see orthopedic surgeon on Wednesday. Can you tell me what questions I should be asking the specialist? Also is it usual us it for C1 not to heal and are there many cases when surgery is not required. Thank you. Forgot to mention no spinal cord damage...
Submitted:
4 Days
Category:
Neurosurgeon
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C1 fractures are usually stable unless there is a ligamental rupture. As in this case your child did not require surgery. But my usual practise is to immobilise the spine with philadelphia collar and not soft collar. Now that we have crossed 5 months, I doubt that anymore fusion might occur at the anterior arch. But still I feel to immobilise with Philadelphia collar for 2 more months and calcium supplements need to be given.
You can check with your specialist and get dynamic X ray's of CV junction, that is, flexion and extension of the cervical spine to look for AAD(atlanto axial dislocation). If there is AAD(less likely in this case) then your child might need a surgery.
Regards
Thank you. If it does not heal what type of physical activity will she be able to do. ( my daughter is part of the elite platform diving programme) I am assuming she will need to avoid all contact sports?? also is there any indication from the image I supplied that this fracture could be congenital??
thank you...
Hello again,
She might not require any physical therapy as such.
As far as contact sports are concerned, better to avoid. I fear that even platform diving might have to be avoided.
Regarding the doubt whether this fracture could be congenital; I could comment if have the same corresponding image taken immediately after the injury for comparison.
Hope this helps, would be glad to answer any further queries.
Thank you. I have uploaded a photo I took from the actual films at time of original injury. I'mnot sure if it will be clear enough to assess if the fracture could be congenital. ( I don't currently have CD copy). Thank you in advance for your best effort. Kind Regards, Kathryn Egan..
Hello.
After seeing the image I feel that it may not be congenital but more likely of traumatic origin. As the immobilisation may not have been perfect, there is non union and also the fracture fragments have displaced further especially during the growing age(12-18yrs). I feel that the present fracture might not unite but the good thing is, as far as the ligaments are intact it should not pose any problem for her in her routine daily activities.
Thank you.
Thank you very much for your assistance. I appreciate you being so prepared to answer further questions. Yes we had noted that the fracture seems to have got bigger - it is on our list of questions for tomorrow. I think this is an excellent service and will recommend to my friends. Kind Regards, Kathryn Egan.