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
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
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.