Atlanto-occipital dislocation in children: saving a life in the trauma field

Traumatic atlanto-occipital dislocation is (AOD) a serious injury of the cervical spine that occurs in children. It is more common than previously thought and is estimated to account for 6–8 % of all fatal traffic injuries. The cause is usually a high energy trauma, resulting in a disruption of the ligaments and membranes that give support to the craniocervical junction between the occiput and the proximal cervical vertebrae. These supporting structures are incompletely developed in children, thus predisposing the paediatric population to develop an atlanto-occipital dislocation under traumatic circumstances. Early recognition and improved pre-hospital care have increased the survival rate and yielded a better prognosis for these children. Therefore, every high energy trauma, for example a traffic accident, should raise suspicion of atlanto-occipital dislocation, especially if combined with a significant head injury. Furthermore, symptoms originating from brain stem and spinal cord injury may be another sign of a dislocation. Early recognition of a possible atlanto-occipital dislocation, stabilisation and management in the trauma field and rapid transportation to the hospital are measures that improve the survival rate and prognosis of these children.

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