Une fracture-luxation antérieure de C3 chez un enfant révélée par un syndrome de Claude Bernard–Horner

Abstract

Injury of the cervical vertebrae in children is very rare, and few cases of dislocation-fracture in the cervical vertebrae below C3 have been reported. We experienced a child case who had a very rare C3/4 flexion-distraction type spinal injury accompanying C5 level spinal cord injury and Horner’s syndrome caused by sympathetic trunk palsy. The patient was a 5-year-old boy. The boy was thrown head first from the backseat of a car in a traffic accident, pinning the neck between the broken window and guardrail. The patient, with an 8 cm long injury to the left upper clavicle region, was transported to a medical emergency center, and referred to our hospital after initial treatment. At the first examination, torticollis with neck pain and limitation of left palpebral opening were observed. The strength of bilateral muscles in the upper limbs was grade 1/5 muscle weakness in the deltoid muscles, 3/5 in the biceps, and 4/5 in others. The injury was diagnosed as a C3 anterior dislocation-fracture by plain radiography and computed tomography. The dislocation was reduced by glisson traction, but the operation of posterior cervical fixation (C3/4 spinous process wiring) was needed because it was difficult to maintain the reduced position using a fixation device. The postoperative course was good, and bony union was obtained. The strength of muscles in the upper limbs improved to 3/5 in the deltoid muscles, 4/5 in the biceps, and 5/5 in others, and Horner’s syndrome also improved.