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Occult fracture-dislocation of the cervical spine

A case report and review of the literature

Fracture-luxation méconnue du rachiscervical

Summary

Occult injuries of the cervical spine in certain patients may lead to misdiagnosis or delayed diagnosis and treatment. The authors present a patient with an occult cervical spinal fracture-dislocation and review the literature. A 37 year-old male was involved in a motor vehicle accident. At his admission, the patient was alert and denied any pain in the cervical region, as well as neurologic symptoms. Physical examination revealed painless range of motion of his neck and no sensory or motor deficits. Plain radiographs of the cervical spine showed unilateral dislocation of C4 on C5 vertebra with fracture of the left facet of C5 vertebra. Computed tomography scanning showed no neural compression. Operative reduction, stabilization and arthrodesis of the spine were advised, but the patient refused operative treatment. One year after his initial injury, the patient presented with torticollis and no neurologic symptoms.

Résumé

Des traumatismes méconnus du rachis cervical peuvent conduire à des diagnostics erronés ou entraîner des retards diagnostiques et thérapeutiques. Les auteurs rapportent le cas d'un patient présentant une fracture-luxation méconnue et font à ce propos une analyse de la littérature. Cet homme de 37 ans avait été victime d'un accident de circulation automobile. A l'admission il était alerte et ne se plaignait d'aucune douleur cervicale ni d'aucun signe neurologique. L'examen clinique montrait une mobilité cervicale normale et indolore et ne retrouvai aucun déficit sensitivo-moteur. Les radiographies standards devaient cependant montrer une fracture-luxation de C4 sur C5 avec une fracture articulaire gauche de C5. La scanographie ne révéla aucune souffrance neurologique. La réduction chirurgicale, la stabilisation avec arthrodèse fut proposée mais le patient refusa tout traitement opératoire. Une année après l'accident le patient fut revu pour un torticolis sans signes neurologiques.

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Correspondence to D. S. Korres.

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Korres, D.S., Papagelopoulos, P.J., Petrou, H.G. et al. Occult fracture-dislocation of the cervical spine. Eur J Orthop Surg Traumatol 9, 195–199 (1999). https://doi.org/10.1007/BF00542592

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Key words

  • Cervical spine
  • Fracture dislocation
  • Occult spine injury

Mots-clés

  • Rachis cervical
  • Fracture luxation
  • Occult fracture