Odontoid Fractures

Abstract

Pediatric odontoid fractures are rare but should be suspected in any child at risk for cervical spine trauma. Injuries to the odontoid have occurred even with relatively minor injuries such as ground-level falls. The fulcrum of motion in pediatric patients is at the C2-C3 level resulting in a greater risk of upper cervical fractures. Under the age of 7 years, the most common odontoid fracture is through the cartilaginous synchondrosis between the odontoid process and the body of the axis. Adolescents who sustain an odontoid fracture after synchondrosis fusion can be classified using the Anderson and D’Alonzo criteria and treated appropriately. A thorough clinical and radiographic evaluation is critical. Treatment options include both non-operative and operative options. Synchondrosis fractures will heal reliably with external immobilization. Non-union after treatment is rare. Surgery is reserved for patients who fail conservative treatment, with loss of reduction, nonunion, or neurological symptoms. A neurological deficit is uncommon with these injuries. If an odontoid fracture is neglected, nonunion may occur with the development of an os odontoideum and subsequent atlantoaxial instability. This chapter discusses non-operative and operative treatment, imaging studies, and potential complications in the management of pediatric odontoid fractures.