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Traumatic Posterior Atlanto-occipital Dislocation With Three-part Jefferson Fracture and Subaxial Distractive Extension Injury

No previous reports have described combined upper and lower cervical injuries caused by a contrary injury mechanism. A 44-year-old man was transferred complaining of quadriplegia caused by a rear-end collision car accident. CT and MRI findings revealed posterior atlanto-occipital dislocation (AOD) w...

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Autores principales: Chang, Dong-Gune, Lee, Jae Won, Park, Jong-Beom, Kim, Jaehoon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8288893/
https://www.ncbi.nlm.nih.gov/pubmed/34270464
http://dx.doi.org/10.5435/JAAOSGlobal-D-21-00070
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author Chang, Dong-Gune
Lee, Jae Won
Park, Jong-Beom
Kim, Jaehoon
author_facet Chang, Dong-Gune
Lee, Jae Won
Park, Jong-Beom
Kim, Jaehoon
author_sort Chang, Dong-Gune
collection PubMed
description No previous reports have described combined upper and lower cervical injuries caused by a contrary injury mechanism. A 44-year-old man was transferred complaining of quadriplegia caused by a rear-end collision car accident. CT and MRI findings revealed posterior atlanto-occipital dislocation (AOD) with three-part Jefferson fracture and subaxial distractive extension (DE) injury at the C3-4 and C6-7 levels. MRI showed spinal cord injury at C3-4 and C6-7, which caused quadriplegia and respiratory failure. When the patient arrived at the emergency department, he was already intubated because of respiratory failure. The patient was also hemodynamically unstable after lung injury and pelvic bone fracture. The patient died 1 day after the accident before undergoing surgical intervention. To the best of our knowledge, this is the first report of a case of a traumatic posterior AOD with three-part Jefferson fracture and subaxial DE injury caused by a contrary injury mechanism. Subaxial DE injury, not posterior AOD, caused fatal situation in this case. High index of suspicion and careful radiologic examination are needed to investigate the presence of associated lower cervical spine injury caused by a contrary injury mechanism in traumatic posterior AOD, which may affect treatment, outcome, and prognosis.
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spelling pubmed-82888932021-07-20 Traumatic Posterior Atlanto-occipital Dislocation With Three-part Jefferson Fracture and Subaxial Distractive Extension Injury Chang, Dong-Gune Lee, Jae Won Park, Jong-Beom Kim, Jaehoon J Am Acad Orthop Surg Glob Res Rev Case Report No previous reports have described combined upper and lower cervical injuries caused by a contrary injury mechanism. A 44-year-old man was transferred complaining of quadriplegia caused by a rear-end collision car accident. CT and MRI findings revealed posterior atlanto-occipital dislocation (AOD) with three-part Jefferson fracture and subaxial distractive extension (DE) injury at the C3-4 and C6-7 levels. MRI showed spinal cord injury at C3-4 and C6-7, which caused quadriplegia and respiratory failure. When the patient arrived at the emergency department, he was already intubated because of respiratory failure. The patient was also hemodynamically unstable after lung injury and pelvic bone fracture. The patient died 1 day after the accident before undergoing surgical intervention. To the best of our knowledge, this is the first report of a case of a traumatic posterior AOD with three-part Jefferson fracture and subaxial DE injury caused by a contrary injury mechanism. Subaxial DE injury, not posterior AOD, caused fatal situation in this case. High index of suspicion and careful radiologic examination are needed to investigate the presence of associated lower cervical spine injury caused by a contrary injury mechanism in traumatic posterior AOD, which may affect treatment, outcome, and prognosis. Wolters Kluwer 2021-07-16 /pmc/articles/PMC8288893/ /pubmed/34270464 http://dx.doi.org/10.5435/JAAOSGlobal-D-21-00070 Text en Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Chang, Dong-Gune
Lee, Jae Won
Park, Jong-Beom
Kim, Jaehoon
Traumatic Posterior Atlanto-occipital Dislocation With Three-part Jefferson Fracture and Subaxial Distractive Extension Injury
title Traumatic Posterior Atlanto-occipital Dislocation With Three-part Jefferson Fracture and Subaxial Distractive Extension Injury
title_full Traumatic Posterior Atlanto-occipital Dislocation With Three-part Jefferson Fracture and Subaxial Distractive Extension Injury
title_fullStr Traumatic Posterior Atlanto-occipital Dislocation With Three-part Jefferson Fracture and Subaxial Distractive Extension Injury
title_full_unstemmed Traumatic Posterior Atlanto-occipital Dislocation With Three-part Jefferson Fracture and Subaxial Distractive Extension Injury
title_short Traumatic Posterior Atlanto-occipital Dislocation With Three-part Jefferson Fracture and Subaxial Distractive Extension Injury
title_sort traumatic posterior atlanto-occipital dislocation with three-part jefferson fracture and subaxial distractive extension injury
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8288893/
https://www.ncbi.nlm.nih.gov/pubmed/34270464
http://dx.doi.org/10.5435/JAAOSGlobal-D-21-00070
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