Displaced fracture through the anterior atlantal synchondrosis

In the acute setting, accurate radiological interpretation of paediatric cervical spine trauma can be difficult due to a combination of normal variants and presence of multiple synchondroses. We present a rare case of a fracture through the anterior atlantal synchondrosis in a paediatric spine. A five-year-old boy, who fell backwards onto the top of his head while swinging across on a monkey bar frame, presented with neck pain, cervical muscle spasm and decreased right lateral rotation and extension of his neck. Computed tomography showed a displaced diastatic fracture through right anterior atlantal synchondrosis. There are only 12 cases of paediatric C1 fractures reported in the world literature. The importance of considering this diagnosis in the appropriate clinical setting, and the normal variants in the paediatric atlas that can cause diagnostic dilemma to the interpreting radiologist, are discussed in this case report.     

Congenital synchondroses in the ischial bones

In this paper, a 39-year-old woman is presented with congenital, symmetrically bilateral synchondroses in the bodies of the ischial bones, which presumably occurred due to extension of two separate primary ossification centers which failed to fuse, instead of a usual single primary ossification center. To the best of the author's knowledge, such an anomaly has not been reported previously in the ischial bones. The apparent clinical significance of these synchondroses was development of degenerative changes about them, which was associated with moderate hip pain in the absence of degenerative hip-joint disease. Received 28 September 1995; Revision received 29 April 1996; Accepted 2 May 1996     

自体肋软骨耳廓成形术术前肋软骨自动乳腺全容积成像系统显像

目的分析自动乳腺全容积成像系统(ABVS)在成人右侧第6～9肋软骨以及6、7及7、8肋软骨联合部位的成像特点,评估其在自体肋软骨耳廓成形术术前肋软骨影像学评估中的价值。方法对40名志愿者右侧胸廓行超声AB-VS检查,观察右胸肋软骨及肋软骨联合部位的冠状面超声声像图特点,并测量第6～9肋软骨及6、7与7、8肋软骨联合的长、宽、厚径;同时观察并分析肋软骨的钙化显示率。结果 ABVS可清晰显示成人肋软骨及肋软骨联合部位的内部细节及空间形态特征,冠状面图像可显示2～4个肋软骨联合及相邻肋软骨。6、7及7、8两组肋软骨联合的显示率均为100%;男性第6～9肋软骨及6、7及7、8肋软骨联合的长径及宽径大于女性(P<0.05),男、女性各厚径差异均无统计学意义(P均>0.05);两性别间第6～9肋软骨钙化灶显示率差异无统计学意义(χ2=1.230,P>0.05)。结论 ABVS对肋软骨及肋软骨联合成像有效可行,对自体肋软骨耳廓成形术术前评估有重要意义。     

Injuries of the cervical spine in children

Summary Injuries of the spine in children rarely occur. They amount to about 0.2 % of all fractures and dislocation and to 1.5 to 3 % of all lesions of the spine. The younger an injured child is, the more likely it has sustained a lesion of the upper cervical spine. This spinal segment in comparison to adults is concerned more often and accounts for 50 % of all C-spine injuries. Important differences between the adult spine and the spine in the child disappear with the age of 10 years. Later diagnostics, classification and treatment correspond widely with the principles valid in adults. The knowledge of the normal shape and development of the spine are crucial in avoiding misinterpretations of X-ray films. Typical examples include the confusion of synchondrosis with fractures or of subluxations of the atlas and the C2/C3 segment with “true” instabilities. Relevant lesions always are accompanied by clear clinical symptoms. Specific injuries of the growing axial skeleton are lesions of the cartilaginous endplates and “fractures” of the synchondrosis. Atlantooccipital dislocations (AOD) occur typically in children. According to our experiences with 16 AOD we propose – dependent on the direction of dislocation of the occipital condyles – a simplified classification in anterior, posterior and completely unstable AOD. In one boy in our series we treated the lesion successfully by temporary interal fixation. He presented a massive improvement of initially subtotal neurologic symptoms. Injuries to the synchondrosis of the dens represent another typical lesion in childhood. Four out of 5 children treated in our clinic were involved as back seat passengers in head-on motor vehicle accidents. Three of them were restrained by 4 point children's seat harnesses. For conservative treatment we prefer a halo and plaster-vest for 12 weeks after closed reduction. We recommend operative treatment in cases of major dislocation with greater instability where it may be impossible to maintain alignment with halo fxation. Surgical equipment and techniques correspond in detail to those used in adults. Three of the five children mentioned have been stabilized successfully by anterior screw fixation. Atlantoaxial dislocations (AAD) are devided into translatory and rotatory instabilities. Sagittal dislocations of the atlas in children also need to be fixed by a fusion between C1 and C2. Rotatory instabilities in the acute phase are easy to reduce and are treated with a halo-fixator. According to our experiences in two delayed cases anatomical reduction is also possible after months partly by open, partly by closed means. For the lower C-spine lesion with encroachment of the spinal canal and above all ligamentous injuries represent a clear indication for operative treatment because, similar to the adult spine, they do not become stable after close management.      

Surgically treated traumatic synchondrotic disruption of the odontoid process in a 15-month-old girl

A case of traumatic synchondrotic disruption in a 15-month-old girl is reported; she was treated with interlaminar wiring of C1–C2 without grafting. Reduction of the dislocation and angulation and stability were achieved without evidence of growth disturbance. However, the child's initial poor neurological status with tetraplegia below the level of C7 remained unchanged. Besides our case, there are only three other cases in the literature of young children primarily operated on for a traumatic odontoid synchondrotic disruption. Even though the dorsal interlaminar wiring of C1–C2 without grafting is an easy and safe procedure even in the very young, the optimal form of treat-ment for this rare injury is still unsettled. Received: 7 May 1997     

The stress at the human atlanto-occipital joint

Summary The development of the occipital condyle has been observed in human fetuses, neonates, children, and juveniles. In contrast to some authorities, the authors believe the occipital condyle to originate from the basioccipital and the exoccipital of the occipital bone. The bony parts of the condyle are divided by the synchondrosis intraoccipitalis anterior. The rostral area on the basioccipital occupies about one-fourth to one-seventh of the surface of the subchondral bone. The sequence and mode of ossification of the synchondrosis intraoccipitalis anterior has been investigated. A causality between the synchondrosis and the occasionally observed subdivisions of the articular surface in the adult does not exist.Dedicated to Prof. Dr. H. Leonhardt on the occasion of his sixtieth birthday     

Arthritis psoriatica mit Manifestation an der Synchondrosis sternalis superior

Zusammenfassung Es wird die bildgebende Diagnostik der Manubriosternalgelenksarthritis im Rahmen einer Psoriasisarthritis bei einem 64j?hrigen Patienten beschrieben. Die Mitbeteiligung des Manubriosteranlgelenkes (Synchondrosis sternalis) ist eine seltene Manifestation der Psoriasisarthritis. Es werden die Befunde der Skelettszintigraphie, der konventionellen R?ntgendiagnostik und der Arthrosonographie der Manubriosternalgelenksarthritis demonstriert und diskutiert. Eingegangen: 14. September 1998 Akzeptiert: 4. Februar 1999