Pediatric Axis Fractures: Early Halo Immobilization, Management and Outcome

Mandabach, Mark G.; Ruge, John R.; Hahn, Yoon S.; McLone, David G.

doi:10.1159/000120737

Cited by 65 publications

(45 citation statements)

References 27 publications

(47 reference statements)

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“…In this search we found four patients, who were combined with patients from six other reported series in the literature (Table 1). 1,3,[6][7][8]10 Data regarding age, sex, fracture displacement/angulation, delay in diagnosis, neurological deficits, treatment strategy, and outcome were collected from all series.…”

Section: Clinical Materials and Methodsmentioning

confidence: 99%

Odontoid synchondrosis fractures in children

Fassett¹,

McCall²,

Brockmeyer³

2006

FOC

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Object 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. Methods 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. 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. Conclusions 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.

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Section: Clinical Materials and Methodsmentioning

confidence: 99%

Odontoid synchondrosis fractures in children

Fassett¹,

McCall²,

Brockmeyer³

2006

FOC

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“…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.…”

Section: -23mentioning

confidence: 99%

“…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.…”

Section: Pathogenesismentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

“…1,[11][12][13]22,23 Despite the fact that there is a 43% complication rate and up to 10% of the failure of fusion was reported, Halo orthosis has been observed to be the most beneficial approach in the two limited clinical series. 12,18 New modifications in the Halo crown and pins' design, as well as its applied torque, have recently demonstrated a dramatic reduction in the complications attributed to this procedure. The changes have yielded a successful set of data supporting Halo-vesting to be the most commonly used orthoses for treating unstable pathologies of the cervical spine in small children.…”

Section: Introductionmentioning

confidence: 99%

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

Rahimizadeh¹,

Williamson²,

Rahimizadeh³

et al. 2017

Orthop Res Traumatol Open J

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Upper cervical spine injuries are the most common form of spinal cord trauma that occur in preschool children. Among such injuries, odontoid synchondrosis fractures are the most frequently observed, though relatively few cases have been reported in the medical literature. The most appropriate approach to describe such cases is physeal injuries of the basilar synchondrosis plate between the odontoid process and the body of the axis. Acute odontoid synchondrosis fractures are further classified into 3 subtypes based on the amount of dense displacement and the degree of fracture angulation. Type Ic, the most severe subtype, will require a posterior atlantoaxial fixation for an associated atlantoaxial subluxation. The majority of Type Ia and type Ib odontoid synchondrosis fractures that display only mild to moderate dense displacement and angulation, can be adequately addressed through proper fusion. Complete fusion may be achieved through external immobilization after careful alignment is reached by either Minerva Orthosis or the use of a Halo-vest. Regardless of the technique applied, prior to immobilization, acute synchondrosis fractures should be brought together through either neck hyperextension or by using the skull traction procedure. While Minerva orthosis has been effective in the treatment for two case series and a few case reports, the use of Halo-vesting in young children presents challenges due to decreased skull thickness and the presence of a certain amount of soft osseous tissue. For these reasons, a certain level of controversy exists in the medical literature as to whether the use of such a device is warranted. According to the opponents of this practice, Halo-vesting is often a frustrating and anxiety-provoking experience for young patients. They likewise draw attention to the concerns and hospitality anticipated from the caregivers of such children who have been vested. Furthermore, these authors document that Halo orthosis is associated with a higher percentage of complications such as pin site infections, pin loosening or dislodgement, the breakdown of skin, dysphagia, dural tears and even brain abscesses. Conversely, proponents believe that Halo-vesting is a well-tolerated procedure in a majority of children as well as in toddlers. In accordance with this belief, existing evidence demonstrates that with a modification in the pin number, pin design, location of insertion, and insertion torque, the incidence of pin dislodgement and pin loosening may be reduced. Moreover, pin-site infections can be prevented through periodic medical supervision of the child patient as well as educating caregivers on how to properly clean and monitor pin sites. Overall, the number of the children with odontoid synchondrosis fractures, who have been treated with Halo-vesting accounts for roughly 40 cases with a mean percentage of complication rate recorded at 40%. Herein, 3 young children with acute odontoid synchondrosis fractures are reported in whom solid fusion at the synchondrosis plate was achieved t...

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Spinal Cord Injury in Pediatric Patients

Aldana¹,

Brockmeyer²

2007

Surgical Management of Spinal Cord Injury

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Pediatric Axis Fractures: Early Halo Immobilization, Management and Outcome

Cited by 65 publications

References 27 publications

Odontoid synchondrosis fractures in children

Odontoid synchondrosis fractures in children

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

Spinal Cord Injury in Pediatric Patients

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