Synchondral Fracture of the Posterior "Hemiarch" of Pediatric Atlas with Cerebrospinal Fluid Fistula following a Penetrating Neck Injury

Introduction: As such, the incidence of spinal fractures in young children is less than that of adults due to an increased pliability of the immature bones. The presence of unfused synchondroses in these children predisposes them to an infrequent pattern of fractures that traverse through ossification centers. Such synchondral injuries are uncommonly reported in the C1 and C2 vertebrae. Those that have been occasionally described in C1 involved the anterior synchondrosis. Furthermore, penetrating injuries to a pediatric spine are relatively rare. Case Presentation: In this context, we present a 4-year-old child in whom a penetrating injury to an immature atlas led to an unusual disjunction of the posterior synchondrosis with fracture displacement of the posterior "hemiarch" of the atlas that plunged into the dura, resulting in a cerebrospinal fluid fistula. Conclusion: We discuss the possible mechanism and considerations in the management of this unique presentation. Such an atypical fracture pattern involving the posterior hemi ring of the pediatric atlas is previously unknown.