A 4-year-old female presented to the emergency department after a fall from a trampoline. On examination, she was awake and alert but crying, with mild neck tenderness but no other injuries found. Radiographs were ordered to rule out cervical spine injury due to the mechanism of injury and neck tenderness on examination.

2.  4 yo F presents to the ED after
a fall from the
trampoline, and parents
noticed that she seemed weak
all over. Pt has no obvious
injuries. She is
awake, alert, but crying.
VS: Temp 98, HR 110, BP 90/70
RR 17, O2Sat: 100% RA
PE:
WNWD, NAD, A&Ox3, anxio
us and crying
HEENT: NCAT; ENT: WNL
NECK: mild tenderness to
palpation, no step-offs
Neuro: CN II-XII intact, PERRL
Ext: MAEW, motor/sensations
intact, reflexes wnl, 2+DP
bilat.
Rest of exam unremarkable, no
signs of trauma in
extremities.

3. http://www.hawaii.edu/medicine/pediatrics/pemxray/v1c05.html

4. •
http://www.hawaii.edu/medicine/pediatrics/pemxray/v1c05.html
Disscussion
• a physiologic misalignment
that normally occurs in
children
• 40% of <7 yr, still present in
20% up to 16 yr
• 40% of children at C2-C3
level and in 14% of children
at the C3-C4 level
• 70% of C-spine fx in infants
and children occur from C1 to
C3
© 2000 by the Rector & Visitors of the University of Virginia
http://www.med-ed.virginia.edu/courses/rad/cspine
/

5. http://www.med-ed.virginia.edu/courses/rad/cspine/interpretation2.html

6.  Cervical spine immobilization until true subluxation is
ruled out
 No immobilization is necessary when diagnosis of
pseudosubluxation is made
 Pain management
 Outpatient follow-up