New C2 synchondrosal fracture classification system

Abstract

background• C2 is the most commonly injured vertebrae in young children being uniquely susceptible to injury for a variety of reasons: C2 anatomical structure, ligamentous laxity, relatively hypotonic upper cervical musculature, upward shifted biomechanical fulcrum, and large cranial body ratio . We believe this classification system has utility in diagnosis and treatment planning for C2 synchondrosal fractures, however, it only referred to fractures involving one of the central synchondroses.• We observed a spectrum of central C2 synchondrosal fractures at our institution over the last 19 years, including 2 fracture patterns not previously reproted. We propose a new classification system which allows for distinction of C2 synchondrosal fracture types based on central synchondrosis anatomy.

Use of halo fixation therapy for traumatic cranio-cervical instability in children: a systematic review

“…We identified eight studies, five of them favoring primary therapy with HF [ 37 , 39 , 42 , 46 , 47 ]. Takahashi et al [ 43 ] used HF prior to surgery and other authors used it after surgery [ 18 , 30 ].…”

“…Fulkerson et al recommend that early surgical intervention should be considered in cases of odontoid angulation (> 30°), significant displacement (> 11%), and symptoms of spinal cord injury due to a higher probability of ligament disruption and greater instability of the fracture [ 16 ]. Synchondrosal fracture—new classification system A new classification of C2 synchondrosal fractures in children has been proposed by Rusin et al [ 37 ]. Type I fractures, described in 64% of the cases, were only treated with primary surgical fixation in two cases and with primary HF in six cases.…”

Management of cervical spine trauma in children

“…The developing C2 vertebra consists of five ossification centres separated by six synchondroses. These synchondroses close between the ages of 7 and 13.5 years [39]. In young children, odontoid peg fractures usually occur through the synchondrosis between the C2 body and the peg.…”

“…In young children, odontoid peg fractures usually occur through the synchondrosis between the C2 body and the peg. Synchondrosal fractures have been classified based on their pattern by Rusin et al and usually heal well with external fixation [39]. Once the synchondroses have closed, injuries can be classified as per adults, using the Anderson and D’Alonzo classification [2].…”

Neurophysiological monitoring of displaced odontoid fracture reduction in a 3-year-old male

“…Pediatric spine injuries are relatively rare with incidence in the literature ranging from 0.2 to 0.5% of all fractures and 2.7 to 9% of all spinal injuries [1,2]. Younger patients are more likely to present with upper cervical spine involvement due to their anatomy; a greater head-toneck ratio, ligamentous laxity, underdeveloped neck muscles, horizontal facets, and physiologic wedging of the vertebra [3][4][5][6]. Furthermore, C2 is particularly susceptible given that the cartilaginous plate between the odontoid process and the axis does not fuse until the age of 5-7 [6][7][8].…”