Odontoid synchondrosis fractures in children

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Odontoid synchondrosis fractures, although rare in the overall incidence of spinal trauma, are one of the more common fractures in young children. The goal of this study was to evaluate the demographic data, incidence of neurological deficits, treatment strategies, and outcomes in a combined series of odontoid synchondrosis fractures treated at the authors' institution and reported in other series.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>In a retrospective chart review, the authors identified four odontoid synchondrosis fractures treated at their hospital since January 2000; these were combined with cases reported in six other series in the literature, yielding a total of 55 patients. Data regarding the patients' age, sex, delayed diagnosis, odontoid displacement, neurological deficits, treatment, and fusion status were collected.</jats:p> <jats:p>The patients' ages ranged from 9 months to 7 years (mean 2.8 years), with neither sex predominating. Diagnosis was delayed in eight cases. The orientation of the odontoid fracture was reported for 36 patients, with 94% experiencing anterior displacement. Spinal cord injury (SCI) was noted in 15 patients, including 11 with complete injuries and eight with SCI at the cervicothoracic junction. Forty-two (93%) of 45 patients with fractures initially treated with external immobilization attained fusion. Eight patients were treated with surgery; four initially, with no attempt at conservative therapy, three after failed halo immobilization, and one after nonunion because of delayed diagnosis.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Odontoid synchondrosis fractures can be difficult to diagnose. In children younger than 7 years of age who present with neck pain or neurological deficits attributable to SCI, this fracture should be suspected. Given the high rate of fusion attained with conservative therapy, it is recommended for most synchondrosis fractures, although surgery may be warranted for individual cases.</jats:p></jats:sec>

Halo-Vesting in Preschool Aged Children with Synchondrosis Fracture: A Case Series which Explores the Current Techniques Associated with this Procedure

“…20,23 In the middle of the spectrum, are the children experiencing neck pain, flexion deformity and limited neck mobility or torticollis. 17 According to Fassett et al 16 about two thirds of the patients remain asymptomatic or report only neck pain. In these patients, the correct diagnosis raises a high index of suspicion.…”

“…It has been shown that the younger the child is at the time of injury, the more likely the injury is to occur in the region of the upper cervical spine. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] This specific region has several characteristics that predispose it to such injuries including: increased ligamentous laxity, more horizontally oriented facet joints, less mature bone ossification, weak neck muscles, higher fulcrum of the cervical spine, and most importantly, the child's greater head-to-body ratio. It is because of this greater ratio that more forces are directed towards the junction between the larger head and the smaller body.…”

“…As a result of such a flexion injury, the fractured dense tends to be displaced anteriorly marked by the presence of a resultant variable angulation. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Extension injuries of the plate will occur rarely, being manifested only with the posterior displacement of the dense.…”

“…Since this cartilaginous plate does not ossify until a child is 7-years-old, this developing region of the spine remains an area of potential weakness in preschool children. 5,[8][9][10][13][14][15][16][17]22,23 Although, rare in the overall incidence of spinal trauma, odontoid synchondrosis fractures are some of the more common fractures that occur in young children. The treatment of acute odontoid synchondrosis fractures in children depends on the amount of broken dense present, its forward displacement, and the angulation at which the injury is inflicted.…”

“…Furthermore, the odontoid process of the axis remains the most vulnerable part of the upper cervical spine when compared with spinal injuries in small children. [8][9][10][11][12][13][14][15][16][17][18][19][20][21] This occurrence is attributed to the anatomical characteristic that the odontoid and the axis are separated by an apophyseal plate. Since this cartilaginous plate does not ossify until a child is 7-years-old, this developing region of the spine remains an area of potential weakness in preschool children.…”