Case Report A 4-Year-Old Who Fell from the Slide Urgent message: Injuries sustained in playground falls are common presentations to emergency departments and urgent care centers alike. The urgent care physician should be alert to the keys to evalu- ation and management of traumatic neck pain. Muhammad Waseem, MD, Lalithambal Venugopalan, MD, and Gerard Devas, MD Introduction C ervical spine (C-spine) injuries occur infrequently in children. This is especially true for fractures of atlas ver- tebra, which is a rare injury in children. Its diagnosis may easily be missed due to inconclusive C-spine radiographs and absence of neurological signs. Here, the authors present an illustrative case of a patient with, and a review of, a fracture of atlas vertebra. FIGURE 1 Case A 4-year-old presented with neck pain one day after he fell from a slide onto the top of his head. He was complaining of pain in the back of his neck. There was no history of loss of consciousness, headache, or vomit- ing. He was immediately placed in a rigid cervical collar. In the emergency department, he was alert and awake. His Glasgow coma scale was 15. His vital signs were as follows: Temperature: 98.4°F Heart rate: 119 beats/minute Respiration: 22 breaths/minute Oxygen saturation: 99% The patient did not have any difficulty of breathing but complained of diffuse neck pain. On physical examination, he had torticollis and dif- fuse tenderness over the back of his neck. There was no subcutaneous emphysema. The pupils were equal and reactive. There was no hemotympanum or cerebrospinal 18 Figure 1. Lateral neck radiograph showing pre-vertebral soft tissue swelling of the upper cervical spine with reversal of normal spine curvature. JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | Fe b r u a r y 2 0 0 8 w w w. j u c m . c o m