Wednesday, July 14, 2010

Traumatic C2 dens fracture (Type II)

16 years old Chinese gentlemen, with no known medical illness

He was alleged MVA on 24/4/10 at 11 am in Klang.
He was a back seat passenger of a car with another 3 friends, while on the way to work.
The car was collided with a lorry.
LOC with unknown exact duration.

He was brought to HTAR with an ambulance. All other three victims died at the scene.

Upon arrival at HTAR, GCS was 7/15 then improved to 12/15 on the same day
Able to move all limbs and had 2 episodes of vomiting upon arrival

On arrival at Neurosurgical Centre;
He was on cervical collar
conscious, alert
GCS: E3V4M6
pupils:3/3 reactive ( left periorbiotal hematoma, cornea looks clear but conjunctiva hemorrhage seen)

L/W over the left frontal region --> T&S done in HTAR
multiple abrasion wound over the face

BP: 120/87
HR: 94
temp:37
SPO2: 100% on air
CT scan brain : Bifrontal contusion with comminuted frontal bone fracture with the involvement of frontal air sinuses (anterior and posterior wall) and thin left frontal EDH






Cervical X-ray shows C2 odontoid fracture




MRI cervical shows anterior displacement of dens with normal cervical cord



CT cervical shows type II odontoid fracture.





He was subjected to odontoid screw placement. Intra-operatively, reduction of displacement was done guided by the image intensifier. Post-operatively, he was extubated with no neurological deficit.

Post-op Cervical X-rays show the position of the screw.


11 comments:

許堅儀許堅儀 said...

Offence is the best defence.............................................................

莊雅和莊雅和莊雅和 said...

Good mind, good find...................................................

魏江伶魏江伶 said...

看得見您的用心~~希望這裡愈來愈熱鬧哦~~............................................................

雅俊芬凱陳許 said...

正點喔 多謝大大無私的分享 感恩拉( ̄∀ ̄)............................................................

h盧aze文lhunt雅er said...

Learn wisdom by the follies of others.............................................................

張志亦劉美玲 said...

婚姻對男人來說是賭他的自由,對女人而言卻是賭她的幸福。.................................................................

凱v胡倫 said...

與人相處不妨多用眼睛說話,多用嘴巴思考. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

凱v胡倫 said...

不費勞力而得者,唯貧困而已................................................

邱思吳佳順翰 said...

Subtlety is better than force. ......................................................................

文王廷 said...

美麗的事物是永恆的快樂,它的可愛日有增加,不會消逝而去................................................

瑋洪洪洪洪洪婷 said...

大肚能容,了卻人間多少事,滿腔歡喜,笑開天下古今愁。..................................................