Preschool Child with Displaced Odontoid Synchondrosis Fracture Treated by Surgical Management Showing Excellent Remodeling

Cervical spine injuries in the children are unusual, and an incidence rate of 1.5-3% of all the spinal fractures has been reported. The cartilaginous end plate between the dens and the body of the axis usually ossifies at the age of 5-7 years. This anatomical characteristic has been attributed to odontoid synchondrosis fractures in young children. However, odontoid process fractures are rare in children and only few cases have been reported in literature. We report a case of a displaced odontoid synchondrosis fracture in a 2-year-old girl with anterior subluxation of C1 over C2 vertebra. This was treated with a posterior atlantoaxial fusion using sublaminar wiring. Immediate post-operative radiography showed partial reduction of the displaced odontoid fragment on C2 body with residual step deformity with angulation at the fracture site. Follow-up at 1 year showed excellent remodeling. Synchondrosis fractures of the odontoid are rare and usually found in children under 7 years of age. Most of these patients can be treated by external immobilization alone. However, in small children with significant displacement and angulation, posterior C1-C2 fusion is a better option providing more stability. Furthermore, one can expect significant remodeling of the fracture within this population.