Odontoid synchondrosis fractures in children

Fassett, Daniel R.; McCall, Todd D.; Brockmeyer, Douglas L.

doi:10.3171/foc.2006.20.2.8

Cited by 53 publications

(36 citation statements)

References 12 publications

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“…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.…”

Section: Clinical Picturementioning

confidence: 99%

“…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%

“…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.…”

Section: Introductionmentioning

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%

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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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Section: Clinical Picturementioning

confidence: 99%