# Successful Non-operative Management of Unstable Jefferson Fracture With Transverse Atlantal Ligament Injury (Dickman Type I and IIb) in a Pediatric Patient: A Case Report

## TL;DR

A child with a rare and unstable neck fracture made a full recovery using non-surgical treatment, adding to the understanding of managing such injuries in children.

## Contribution

This case report demonstrates successful conservative treatment of a rare pediatric C1-C2 trauma with transverse atlantal ligament injury.

## Key findings

- The patient fully recovered with conservative treatment using a halo vest and SOMI brace.
- CT and radiographs showed solid reattachment of the avulsed bony fragment and no instability.
- The case supports non-operative management for unstable Jefferson fractures in children.

## Abstract

This report presents the case of a Jefferson fracture (posterior arch fracture) associated with an unstable avulsion fracture and substance injury of the transverse atlantal ligament (Dickman type I and IIb) in an eight-year-old male child. The patient was managed conservatively with external immobilization using a halo vest and a sternal occipital mandibular immobilizer (SOMI) brace and subsequently made a full recovery. Computed tomography (CT) and dynamic cervical spine radiographs at the final follow-up demonstrated solid reattachment of the avulsed bony fragment of the transverse atlantal ligament and no instability at the C1/2 level. This case report adds to the literature on the optimal non-operative management of the rare pediatric unstable C1-C2 trauma.