Diagnosis and treatment of odontoid fracture in children

Abstract

Objective To explore the clinical characteristics and treatment strategies of odontoid fractures in children. Methods A total of 7 pediatric patients with odontoid fractures were analyzed retrospectively. There were 5 males and 2 females with an average age of 5.6 (3-12) years. The causes were traffic accident (n=2) and fall (n=5). All of them belonged to type II fracture according to the Anderson-D'Alonzo classification. And the factures were synchondrosis (n=5) and real (n=2). Two patients had neurologic involvements of unilateral extremity paresthesia (n=1) and high paraplegia (n=1). Five patients underwent closed reduction and Minerva cast immobilization. One senior boy had atlantoaxial fixation and fusion while another patient with unilateral extremity paresthesia temporary atlantoaxial fixation. Results The patient with high paraplegia achieved fair reduction after Minerva cast immobilization, but died 1 month later from severe pulmonary infection. The reminder was followed up for a median period of 34(7-84) months. Complete fracture union was achieved. The median healing time was 2.6(2-4) months. Four patients with Minerva cast immobilization regained excellent cervical motion. The cervical rotation was merely 30 for patients of atlantoaxial fixation and fusion and 65 for those of temporary atlantoaxial fixation. The patient with unilateral extremity paresthesia achieved complete neurologic recovery at 3 months post-operation. Conclusions Most odontoid fractures in children are synchondrosis type. Closed reduction and Minerva cast immobilization is an effective first option for pediatric odontoid fractures. Open reduction and atlantoaxial fixation results in cervical rotation limitation. And it may be used for some select patients. Internal fixation should removed after fracture union. Key words: Fascia dentata; Fractures, bone; Cervical vertebrae; Child