Traumatic longitudinal atlanto-occipital distraction injuries in children.

Traumatic atlanto-occipital dislocation with survival is possible and, in fact may be relatively more common than once thought. The spectrum of neurologic manifestations is broader than previously described and does not necessarily end in death or tragic neurologic deficit. Radiographic diagnosis of this injury may be difficult, particularly in the longitudinal distraction-dislocation type. Although several methods have been proposed to evaluate the atlanto-occipital relationship, none of these is infallible in the recognition of distraction injury in children. Immobilization rather than skeletal traction provides sufficient immediate stabilization when the dislocation at the atlanto-occipital junction is of the longitudinal distraction type. Three cases are reported: in one, death occurred early; in the second, recovery was partial, but sudden death occurred 2 years later; the third child recovered fully.