Delayed diagnosis of a fractured anterior arch of the atlas in a child

Isolated fractures of the atlas are rare in the pediatric population and it is imperative to properly diagnose the injury with accurate radiological evaluation. Herein, we report a case of a six-year-old child who presented with posterior head and neck pain after a fall. His initial workup, which included plain radiographs, missed a fracture of his atlas, which was only later diagnosed with additional imaging. Aside from neck pain, the patient remained neurologically intact and was successfully treated with a hard cervical collar. Isolated pediatric anterior arch fractures of the atlas can be treated conservatively with a hard collar. The case presented here highlights a delayed diagnosis of a fracture of the anterior arch of the atlas. Despite their rarity, various clinicians should maintain a high level of suspicion as these fractures may be easily overlooked in children on plain radiographs.