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World Neurosurgery Apr 2024Combined triple atlas (C1)-axis (C2) fixation has been described in previous literature as a safe, effective, and minimally invasive procedure for complex atlas and...
BACKGROUND
Combined triple atlas (C1)-axis (C2) fixation has been described in previous literature as a safe, effective, and minimally invasive procedure for complex atlas and odontoid fractures that allows for a greater range of motion compared with posterior approaches and atlanto-occipital fusion. However, it is rarely performed due to the occipital-cervical diastasis resulting from often-fractured C1 joint masses. No evidence-based consensus has been reached regarding the treatment of complex atlantoaxial fractures, and the choice of surgical strategy is based only on clinical experience.
METHODS
We report the combined triple C1-C2 fixation technique with manual reduction of the joint masses during patient positioning on the operating table, which allowed for effective stabilization during a single surgical session. We describe our experience in the management of a 75-year-old patient presenting with an acute complex type II fracture of C1, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis.
RESULTS
We provide a step-by-step guide for combined triple C1-C2 anterior fixation with manual fracture reduction and describe the clinical case of an acute complex type II fracture of C1, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis.
CONCLUSIONS
Combined triple C1-C2 fixation represents a safe and efficient minimally invasive anterior approach for complex type II fractures of C1 with type II odontoid fractures. Manual reduction of the joint masses during patient positioning allows for effective stabilization in a single surgical session.
Topics: Humans; Aged; Odontoid Process; Spinal Fractures; Bone Screws; Fractures, Bone; Fracture Fixation; Neck Injuries; Fracture Fixation, Internal
PubMed: 38266989
DOI: 10.1016/j.wneu.2024.01.094 -
Journal of Engineering and Science in... Aug 2024Advancements in automated vehicles may position the occupant in postures different from the current standard posture. It may affect human tolerance responses. The...
Advancements in automated vehicles may position the occupant in postures different from the current standard posture. It may affect human tolerance responses. The objective of this study was to determine the lateral bending tolerance of the head-cervical spine with initial head rotation posture using loads at the occipital condyles and lower neck and describe injuries. Using a custom loading device, head-cervical spine complexes from human cadavers were prepared with load cells at the ends. Lateral bending loads were applied to prerotated specimens at 1.5 m/s. At the occipital condyles, peak axial and antero-posterior and medial-lateral shear forces were: 316-954 N, 176-254 N, and 327-508 N, and coronal, sagittal, and axial moments were: 27-38 N·m, 21-38 N·m, and 9.7-19.8 N·m, respectively. At the lower neck, peak axial and shear forces were: 677-1004 N, 115-227 N, and 178-350 N, and coronal, sagittal, and axial moments were: 30-39 N·m, 7.6-21.3 N·m, and 5.7-13.4 N·m, respectively. Ipsilateral atlas lateral mass fractures occurred in four out of five specimens with varying joint diastasis and capsular ligament involvements. Acknowledging that the study used a small sample size, initial tolerances at the occipital condyles and lower neck were estimated using survival analysis. Injury patterns with posture variations are discussed.
PubMed: 38059268
DOI: 10.1115/1.4063648 -
Traffic Injury Prevention 2022This objective of the present study is to describe the responses of the human head-cervical spine in terms of injuries, injury mechanisms, injury scoring, and quantify...
This objective of the present study is to describe the responses of the human head-cervical spine in terms of injuries, injury mechanisms, injury scoring, and quantify multiplanar loads. Pretest radiographs of pre-screened five human cadaver head-neck complexes were obtained. Cranium contents and sectioned the structure rostral to skull base. The caudal end was embedded, and cervical-thoracic disc was unconstrained condition. The loading was applied as a torque about the occipital condyle joint. The head and T1 were angulated 30 degrees and 25 degrees. Peak forces and moments at the occipital condyles were recorded using a six-axis load cell. After testing, x-rays and CT images were obtained. Injuries were scored using the Abbreviated Injury Scale, AIS 2015 version. The mean age, stature, total body mass, body mass index of the five subjects were as follows: 63 years, 1.7 m, 78.0 kg, and 28.1 kg/m. The mean peak axial force and coronal, sagittal, and axial bending moments were: 754 N, and 36.8 Nm, 14.8 Nm, and 9.5 Nm. All but one specimen sustained injury. Injuries were scored at the AIS 2 level. Two specimens sustained left anterior inferior lateral mass fractures of the atlas. While the transverse atlantal ligament was intact, some capsular ligament involvement was observed. In the other two specimens, although the same injury was noted, joint diastasis of the atlas-axis joint was identified. Using a PMHS model, the present study described the biomechanics of the initially head rotated head-neck complex under lateral bending in terms of injuries, injury mechanisms, quantification of the multiplanar loads at the occipital condyles, and underscored potential injury scoring issues for occupant protection. The issue of diastasis is not addressed in the AIS 2015 version. While this may not always result in immediate instability and require surgical intervention, it may be necessary to revisit this issue. Upper cervical fractures with diastasis and or transverse atlantal ligament involvement may be potential injury scoring factors for AIS consideration.
Topics: Humans; Middle Aged; Accidents, Traffic; Neck; Neck Injuries; Spinal Injuries; Fractures, Bone; Biomechanical Phenomena; Cervical Vertebrae; Posture; Cadaver
PubMed: 36215262
DOI: 10.1080/15389588.2022.2124811 -
Otology & Neurotology : Official... Dec 2020Only a handful of case reports exist describing posttraumatic sutural diastasis in the calvarium and none report concurrent temporal bone involvement. We aim to describe...
OBJECTIVE
Only a handful of case reports exist describing posttraumatic sutural diastasis in the calvarium and none report concurrent temporal bone involvement. We aim to describe diastasis along the temporal bone suture lines in the setting of temporal bone trauma and to identify clinical sequelae.
STUDY DESIGN
Retrospective case review.
SETTING
Tertiary Level 1 trauma center.
PATIENTS
Forty-four patients aged 18 and younger who suffered a temporal bone fracture from 2013 to 2018 were identified. Diastasis and diastasis with displacement at the occipitomastoid, lambdoid, sphenosquamosal and petro-occipital sutures, and synchondroses were determined.
MAIN OUTCOME MEASURES
The presence of temporal bone suture and synchondrosal diastasis following temporal bone trauma. Diastasis was defined as sutural separation of a distance greater than 1 mm in comparison to the contralateral side.
RESULTS
Using our diastasis diagnostic criteria, diastasis occurred in 41.5% of temporal bone fractures. Transverse fracture types were significantly associated with diastasis (p ≤ 0.001). Lower Glasgow Coma Scale (GCS) and loss of consciousness (LOC) were associated with the presence of diastasis with displacement and diastasis (p = 0.034 and p = 0.042, respectively). Otic capsule violation was more common in fractures with diastasis but did not reach statistical significance. There were two cases of cerebrospinal fluid otorrhea and three deaths in cases that featured diastasis.
CONCLUSION
Our findings indicate that diastasis is a positive predictor for higher disruptive force injuries and more severe outcomes and complications. Posttraumatic temporal bone suture diastasis may represent a separate clinico-pathologic entity in addition to the usual temporal bone fracture classification types.
Topics: Adolescent; Child; Cranial Sutures; Fractures, Bone; Humans; Retrospective Studies; Skull Fractures; Sutures; Temporal Bone
PubMed: 32810023
DOI: 10.1097/MAO.0000000000002804 -
Bulletin of Emergency and Trauma Oct 2019Sheno-occipital diastasis happens more frequently in children and is accompanied with neural and vascular injuries leading to a high rate of mortality. We present a rare...
Sheno-occipital diastasis happens more frequently in children and is accompanied with neural and vascular injuries leading to a high rate of mortality. We present a rare type of clival fracture in a 21 years old man who could survive without any deficit even though the fracture extended widely from left Asterion to the right orbit accompanied by widespread damage of the skull base air sinuses in 3D CT scan. To the best knowledge of the authors, neither this type of fracture, nor the clinical presentation, has been reported in relevant literature.
PubMed: 31858006
DOI: 10.29252/beat-070412 -
Child's Nervous System : ChNS :... Apr 2015This study aimed to consider an appropriate treatment for large subgaleal hematoma with skull fracture and epidural hematoma (EDH).
PURPOSE
This study aimed to consider an appropriate treatment for large subgaleal hematoma with skull fracture and epidural hematoma (EDH).
CASE REPORT
A 6-year-old boy presented at our hospital with head trauma, and computed tomography (CT) showed a thin EDH in the right temporo-occipital area and cranial diastasis in the right lambdoidal suture. However, no neurological deficits were identified in the patient. One week after trauma, he visited our hospital again with a massive fluctuant watery mass extending from the forehead to the right temporoparietal areas, and laboratory data revealed that he was anemic. CT showed a massive subgaleal hematoma with extremely high density around the cranial diastasis. Damage of the transverse sinus was suspected, and emergent sinus repair surgery was performed. The surgery disclosed that bleeding from the transverse sinus was flowing out extracranially through the cranial diastasis. The subgaleal and epidural hematomas were removed, and bleeding from the sinus was stopped by dural tacking sutures along the transverse sinus. Postoperative CT demonstrated complete disappearance of epidural and subgaleal hematomas. The patient recovered from general fatigue without blood transfusion and was discharged 9 days after surgery.
CONCLUSIONS
The therapeutic strategy for massive subgaleal hematoma is individualized. However, treatment for massive subgaleal hematoma with skull fracture should not be considered the same as for hematoma without skull fracture. Emergent surgery is recommended before neurological deterioration is recognized in the patient if damage to the dural sinus is suspected.
Topics: Child; Cranial Sutures; Epidural Space; Humans; Male; Skull Fractures; Subarachnoid Hemorrhage, Traumatic; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 25142690
DOI: 10.1007/s00381-014-2531-3 -
Pediatric Emergency Care Feb 2014Epidural hematoma (EDH) in newborn infants is rare compared with other types of intracranial hemorrhages. Furthermore, posterior fossa EDH is extremely rare. We present...
Epidural hematoma (EDH) in newborn infants is rare compared with other types of intracranial hemorrhages. Furthermore, posterior fossa EDH is extremely rare. We present a case of posterior fossa EDH in an infant with Menkes disease with accessory bones in the occiput. A male infant with a condition diagnosed with Menkes disease by prenatal testing was born at 39 weeks via vacuum extraction. The patient presented with a mild tremor at 2 days after delivery. A brain computed tomography (CT) scan showed an acute EDH in the posterior fossa, extending into the occipitoparietal area. Three-dimensional CT and bone window CT scan revealed several accessory bones, diastasis of 1 accessory suture, a communicated fracture, and a linear fracture in the occipital bone. Furthermore, a bone fragment from a communicated fracture displaced toward the inside. The patient was treated conservatively for EDH because of his good general condition. The hematoma gradually resolved, and his tremor did not recur. We suggest the following mechanism of posterior fossa EDH development in our patient: (1) external force was applied to the occiput inside the birth canal during delivery, resulting in diastasis; (2) a communicated fracture occurred, and a bone fragment displaced toward the inside (linear fracture was caused indirectly by the force); (3) a transverse sinus was injured by the fragment; and (4) EDH developed in both the posterior fossa and supratentorial region. Copper deficiency can also cause fragility of connective tissues, vessels, and bones.
Topics: Cesarean Section; Hematoma, Epidural, Cranial; Humans; Infant, Newborn; Male; Menkes Kinky Hair Syndrome
PubMed: 24488163
DOI: 10.1097/PEC.0000000000000078 -
Clinical Orthopaedics and Related... Jun 2012Craniocervical dislocations are rare, potentially devastating injuries. A diagnosis of craniocervical dislocations may be delayed as a result of their low incidence and...
BACKGROUND
Craniocervical dislocations are rare, potentially devastating injuries. A diagnosis of craniocervical dislocations may be delayed as a result of their low incidence and paucity of diagnostic criteria based on CT and MRI. Delay in diagnosis may contribute to neurological injury from secondary displacement resulting from instability. The purpose of this study was to define CT and MRI-based diagnostic criteria for craniocervical dislocations to facilitate early injury recognition and stabilization.
QUESTIONS/PURPOSES
Using CT and MRI, we (1) described the bony articular displacements characterize craniocervical injuries; (2) described the ligamentous injuries that characterize craniocervical injuries; and (3) determined whether neurologic injuries were associated with bony or ligamentous injury.
METHODS
Using a prospectively collected spinal cord injury database, we identified 18 patients with acute, traumatic occipitocervical injuries. We reviewed CT scans and MR images to document the height of the occipitoatlantal and atlantoaxial joints and integrity of craniocervical ligaments. Medical records were reviewed for neurological status. The primary measurements were number of patients with articular displacement, location of bony displacement, and number of patients with ligamentous injury.
RESULTS
Thirteen of 18 patients had displacement outside the normal range. Six patients demonstrated displacement of both occipitoatlantal and atlantoaxial joints, whereas five patients presented with displacement through the atlantoaxial joints only. Two patients had an abnormal basion-dental interval only. Of 17 patients with MR images, the cruciate ligament was injured in 11 patients, indeterminate in four, and intact in two. All five patients with occipitoatlantal articular displacement had injury to the occipitoatlantal capsule. No patient had occipitoatlantal capsular injury without occipitoatlantal articular displacement. Three cases of complete spinal cord injury were found after occipitoatlantal-atlantoaxial dislocations. Three patients with occipitoatlantal-atlantoaxial dislocations were neurologically intact. The five patients with atlantoaxial dislocations and patients without displacement or ligamentous injury were neurologically intact. Five patients had cruciate ligament rupture or indeterminate injury but no joint diastasis.
CONCLUSIONS
The occipitoatlantal joint capsules stabilize the occipitoatlantal joint; disruption of the occipitoatlantal capsule may suggest the presence of instability. Based on these findings, we identified two distinct injury patterns: isolated atlantoaxial injuries (Type I) and combined occipitoatlantal-atlantoaxial injuries (Type II). Occipitoatlantal joint capsule integrity differentiated these subsets and Type II injuries had a higher percentage of complete spinal cord injuries on presentation.
Topics: Adolescent; Adult; Aged; Atlanto-Axial Joint; Atlanto-Occipital Joint; Cervical Vertebrae; Female; Humans; Joint Dislocations; Longitudinal Ligaments; Male; Middle Aged; Tomography, X-Ray Computed; Young Adult
PubMed: 22033875
DOI: 10.1007/s11999-011-2151-0 -
Acta Clinica Croatica Mar 2009Epidural hematoma of the posterior cranial fossa (EHPCF) is a rare complication in head injuries. Furthermore, nonspecific clinical signs and the rare occurrence of this...
Epidural hematoma of the posterior cranial fossa (EHPCF) is a rare complication in head injuries. Furthermore, nonspecific clinical signs and the rare occurrence of this lesion in craniocerebral injuries make the establishment of a diagnosis more difficult. The aim of the paper is to point to the advantages of early diagnosis. During the 1982-2008 period, 18 patients with EHPCF were operated on at University Department of Neurosurgery, Clinical Center of Montenegro in Podgorica. The clinical picture, neuroradiological examination findings and outcome of operated patients were retrospectively analyzed. In our patient series, EHPCF accounted for 0.11% of craniocerebral injuries or 7.9% of epidural hematomas recorded. In 11 cases, the injury was inflicted in traffic accidents and in 7 patients it was caused by fall. Linear fracture of the occipital bone was detected by radiographic investigation in 12, isolated diastasis fracture of lambdoid suture in four, and linear fracture of the occipital bone with diastasis fracture of lambdoid suture in two patients. Glasgow Coma Scale of 8 and less was present in three, 9-12 in seven, and 13-15 in eight patients. The majority of cases (90%) were detected within 24 hours. In all cases, the diagnosis was made by computed tomography. Mortality rate was 11.11%. Early computed tomography of the head in combination with clinical picture and timely surgical intervention could reduce the mortality and morbidity in these lesions.
Topics: Adolescent; Adult; Child; Child, Preschool; Cranial Fossa, Posterior; Female; Hematoma, Epidural, Cranial; Humans; Male; Middle Aged; Young Adult
PubMed: 19623868
DOI: No ID Found -
Anales de Pediatria (Barcelona, Spain :... Aug 2008A female who was born after a gestation of 37 weeks without incident. A caesarean was performed due to cephalopelvic disproportion. She had no clavicles, dehiscence of...
A female who was born after a gestation of 37 weeks without incident. A caesarean was performed due to cephalopelvic disproportion. She had no clavicles, dehiscence of the sagittal suture, large anterior fontanelle and occipital prominence. A chest x-ray, abdominal and brain ultrasound and karyotype, was requested, with changes only seen in the x-ray,, which showe clavicular agenesis and flared chest. Cleidocranial dysostosis was diagnosed a family study was started. There are ten affected members in five generations. The partial or total absence of clavicles, the late closure of cranial sutures and fontanelles, the diastasis of the pubic symphysis and the flared chest during the first days of life, are constant features. Four presented characteristic facies and three delayed onset of first teeth which required extractions. There is hearing loss in three of them. The three documented childbirths were caesarean due to cephalopelvic disproportion. Other alterations are failure to thrive, coxa vara and early osteoarthritis.
Topics: Cleidocranial Dysplasia; Female; Humans; Infant, Newborn; Pedigree
PubMed: 18755123
DOI: 10.1157/13124897