Direct Anterior Screw Fixation for a Pediatric Odontoid Fracture with Associated Skull Fracture: A Case Report

Abstract

The upper cervical spine remains the most susceptible region for spinal trauma in children, with odontoid fractures being the most common ones in this age group. Concomitant traumatic brain injuries or skull fractures can pose therapeutic challenges in such cases. We report a case of an 11-year-old boy who presented in the semiconscious state with a deep scalp laceration in the left frontoparietal region. A computed tomography (CT) scan revealed a depressed skull fracture requiring an emergency left frontoparietal decompressive craniectomy and an associated fracture of the odontoid process at the base with anterior displacement. Odontoid fractures usually heal well after immobilization, and the use of instrumented fusion is still debated in view of skeletal immaturity. The usual management of Halo vest could not be instituted in his case owing to the skull fracture, and a single cannulated screw fixation was done under fluoroscopic guidance. Direct operative fusion of the odontoid process has been described in younger children with apophyseal fractures, but the evidence of such procedures is rare in elder children with a fused odontoid process. This case report, thus, confirms the anterior odontoid screw fixation as an effective mode of treatment in children of the 7- to 12-year age group.