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Delayed diagnosis of fractured anterior arch of the atlas in a young child
  1. Sergio B Sesia1,
  2. Friederike Prüfer2,
  3. Michael Walther3,
  4. Daniel Studer4
  1. 1Department of Pediatric Surgery, University Children's Hospital (UKBB), Basel, Switzerland
  2. 2Department of Paediatric Radiology, University Children's Hospital, Basel, Switzerland
  3. 3Department of Emergency, University Children's Hospital, Basel, Switzerland
  4. 4Department of Orthopedic and Spine Surgery, University Children's Hospital, Basel, Switzerland
  1. Correspondence to Dr Sergio Sesia, sergio.sesia{at}


A 2-year-old girl fell off a bunk bed onto a parquet floor. She immediately reported neck pain and presented with muscle spasm and limited motion of the cervical spine (C-spine). Plain X-rays of the C-spine showed no osseous lesion. Owing to persisting pain and limited motion in the neck, MRI of the C-spine was obtained which revealed intact ligaments and cervical spinal cord, as well as soft tissue swelling in front of the anterior arch of the atlas. Subsequent CT of the C-spine confirmed a complete, undisplaced fracture of the anterior arch of the atlas (Gehweiler type I fracture). A Minerva cast was applied for 2 months, followed by a soft cervical collar. Persistent neck pain and limited range of motion of the neck after a fall may be indicative of atlas fracture that should be ruled out by CT.

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  • Contributors SS, FP, MW and DS conceived and designed the protocol. All authors were involved in amending the protocol. SS wrote the first draft of the manuscript, and all authors contributed to subsequent and final versions.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.