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Atlantoaxial Dislocation in a Child Secondary to a Displaced Chondrum TerminaleA Case Report
John Hammerstein, MD1; Scott Russo, MD1; Ken Easton, MD1
1 1835 Amhurst Street N.E., Grand Rapids, MI 49503. E-mail address for J. Hammerstein: jphammer63@hotmail.com
The Journal of Bone & Joint Surgery.  2007; 89:413-417  doi:10.2106/JBJS.E.00595
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Among children, cervical spinal injuries are rare. When they do occur, younger children sustain more upper cervical injuries than older children do1,2. The spinal anatomy of children (i.e., a disproportionately large head, wedge-shaped vertebrae, and horizontally oriented facets) is different than that of adults and offers little resistance to the high shear forces that predominate in falls and/or motor-vehicle accidents1-5.The tip of the odontoid process is not ossified at birth. The chondrum terminale is a cartilaginous epiphysis at its apex. Fusion of the terminale to the rest of the dens, if it happens at all, does not take place until a child is between ten and thirteen years of age. This physis is a potential weak spot at the C1-C2 junction.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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