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Pediatric Trauma C-Spine X-Ray Ashlea Wilmott PGY-1 Emergency Medicine.

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Presentation on theme: "Pediatric Trauma C-Spine X-Ray Ashlea Wilmott PGY-1 Emergency Medicine."— Presentation transcript:

1 Pediatric Trauma C-Spine X-Ray Ashlea Wilmott PGY-1 Emergency Medicine

2 Objectives Approach to the c-spine film with notable pediatric variations Ossification centre VS fracture Cases covering common pediatric injury patterns

3 We will not cover Non-traumatic findings (ie: epiglottitis, foreign body) Management of fractures Literature review of C-spine rules in children

4 Peds C-Spine Primers 2/3rds of pediatric spinal injuries occur in the C-Spine Many have associated neurologic deficit Pediatric patients injure their c-spine higher than adults

5 Anatomical Differences that Influence C-Spine Injury Big Heads Weak Muscles and Ligamentous Laxity Growth plates and inherently immature bones

6 Pediatric C-Spine < 8-10 yrs

7 Your typical approach… Loss of Lordosis Oval Contour Pseudosubluxation Ossification Centres Pre-dental Space Pseudospread C1 Soft tissue measurements With some pediatric variations…

8 dequacy

9 lignment A- Anterior vertebral line B- Posterior vertebral line C- Spinolaminar line D- Spinous processes

10 Loss of Lordosis Pseudosubluxation

11 Loss of Lordosis Distance between spines not > 1.5X adjacent C1-2 normal up to 10-12mm

12 Pseudosubluxation and Swischuk’s line

13 2mm

14 Child on a Spine board = flexion

15 Alignment - Odontoid Normal up to 7mm of lateral displacement

16 Rotation = False displacement

17 one Oval contour and anterior wedging Ossification centres

18 Contour and Wedging 3mm

19 Ossification Centres C1 3 77

20 Ossification Centres C

21 Odontoid age 4Odontoid age 8

22 Ossification Centres C3-C

23 So many ossification centres…so little memory… The spinous process should be fused by 2-3 years This “wishbone” should fuse with the body by age 6 – can be later in C1 Extra caution with C2’s late fusing centres: – Base of the dens – Top of the dens

24 Growth PlateFracture Smooth, regular boarders Irregular boarders Predictable locationUn predictable location ScleroticNon-sclerotic

25 artilage

26 ensens 5 mm

27 oft Tissue

28 Summary Loss of lordosis, Pseudosubuxation, C1 spread Oval contour, Ant. Wedging, ossification centres As in adults Pre-dental space, Tilt Changes with age

29 Cases to highlight a few points…

30 Case 1 Something just doesn’t look right here…

31 Powers Ratio A-B/C-D < 1 A B D C

32 Case Two

33 A normal Swischuk’s line does not equal pseudosubluxation!

34 Case Three

35 A lucency at the physis is not always just the physis Beware the odontoid and all it’s ossification centres

36 Case Four The absence of a visible neural arch fracture does NOT rule out hangman’s fracture

37 Summary Loss of lordosis, Pseudosubuxation, C1 spread Oval contour, Ant. Wedging, ossification centres As in adults Pre-dental space, Tilt Changes with age


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