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

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.