Abstract
Background
Odontoid synchondral fractures in very young children with displacement/angulation are highly unstable and require surgical intervention. Soft and small bones with poor pull-out strengths make instrumentation and manipulation difficult.
Case report
We report an 18-month-old child with such a fracture where minimal traction made C1–2 dysjunction apparent with neurological worsening. The C1–2 facets were fixed with a short plate and facetal screws. The child had a good outcome.
Conclusion
Traction should be applied cautiously to avoid distraction injuries. Careful intraoperative manipulation should be planned to avoid any pull outs/fractures while realigning the spine and fixing it.
Similar content being viewed by others
References
Fassett DR, McCall T, Brockmeyer DL (2006) Odontoid synchondrosis fractures in children. Neurosurg Focus 20(2):E7
Fulkerson DH, Hwang SW, Patel AJ, Jea A (2012) Open reduction and internal fixation for angulated, unstable odontoid synchondrosis fractures in children: a safe alternative to halo fixation? J Neurosurg Pediatr 9(1):35–41
Salunke P, Karthigeyan M, Sahoo SK, Sunil N (2018) Improvise, adapt and overcome-challenges in management of pediatric congenital atlantoaxial dislocation. Clin Neurol Neurosurg 171:85–94
Blauth M, Otte D, Krettek C (1996) Fractures of the odontoid process in small children: biomechanical analysis and report of three cases. Eur Spine J 5:63–70
Salunke P, Sahoo S, Khandelwal NK, Ghuman MS (2015) Technique for direct posterior reduction in irreducible atlantoaxial dislocation: multi-planar realignment of C1-2. Clin Neurol Neurosurg 131:47–53
Salunke P, Sahoo SK, Deepak AN, Khandelwal NK (2016) Redefining congenital atlantoaxial dislocation: objective assessment in each plane before and after operation. World Neurosurg 95:156–164
Salunke P, Sahoo SK, Sood S, Mukherjee KK, Gupta SK (2016) Focusing on the delayed complications of fusing occipital squama to cervical spine for stabilization of congenital atlantoaxial dislocation and basilar invagination. Clin Neurol Neurosurg 145:19–27
Kennedy BC, D'Amico RS, Youngerman BE et al (2016) Long-term growth and alignment after occipitocervical and atlantoaxial fusion with rigid internal fixation in young children. J Neurosurg Pediatr 17(1):94–102
Keen JR, Ayer RE, Taha A, Zouros A (2019) Rigid internal fixation for traumatic cranio-cervical dissociation in infants and young children. Spine (Phila Pa 1976). 44(1):17–24
Grover PJ, Harris LS, Thompson DNP (2020) Craniovertebral junction fixation in children less than 5 years. Eur Spine J. 29(5):961–969
Author information
Authors and Affiliations
Contributions
Pravin Salunke: Concept and design, critical review, collection, collation of data and manuscript drafting
Parth Jani: Collection, collation of data, and manuscript drafting
Sushanta K Sahoo: Collection, collation of data, and manuscript drafting
Chandrashekhar Gendle: Data collection and collation, manuscript drafting
Corresponding author
Ethics declarations
The parents of the patient have consented for publication of the case.
Conflict of interest
The authors declare that there is no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Salunke, P., Jani, P., Sahoo, S.K. et al. Displaced odontoid synchondrosis fracture with C1-2 dysjunction in an 18-month-old child: challenges and solutions. Childs Nerv Syst 37, 1377–1380 (2021). https://doi.org/10.1007/s00381-020-04848-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-020-04848-4