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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 6, 789-796.
doi: 10.1302/0301-620X.91B6.22173  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Fractures of the odontoid in children with an open basilar synchondrosis

H. S. Hosalkar, MD, MBMS(Orth), FCPS(Orth), DNB(Orth), Clinical Instructor1; J. N. Greenbaum, MD, MBA, Resident2; J. M. Flynn, MD, Associate Professor3; D. B. Cameron, BA, Research Co-ordinator3; J. P. Dormans, MD, Professor3; and D. S. Drummond, MD, Emeritus Chief, Professor4

1 University of Pennsylvania School of Medicine, 2nd Floor Silverstein, 3400 Spruce Street, Philadelphia, Pennsylvania 19104, USA.
2 Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA.
3 Department of Orthopaedic Surgery
4 Division of Orthopaedic Surgery Children’s Hospital of Philadelphia, 2nd floor, Wood building, 34th Civic Center Boulevard, Philadelphia, Pennsylvania 19104, USA.

Correspondence should be sent to Dr H. S. Hosalkar; e-mail: Harish.hosalkar{at}uphs.upenn.edu

Fractures of the odontoid in children with an open basilar synchondrosis differ from those which occur in older children and adults. We have reviewed the morphology of these fractures and present a classification system for them.

There were four distinct patterns of fracture (types IA to IC and type II) which were distinguished by the site of the fracture, the degree of displacement and the presence or absence of atlantoaxial dislocation. Children with a closed synchondrosis were classified using the system devised by Anderson and D’Alonzo. Those with an open synchondrosis had a comparatively lower incidence of traumatic brain injury, a higher rate of missed diagnosis and a shorter mean stay in hospital. Certain subtypes (type IA and type II) are likely to be missed on plain radiographs and therefore more advanced imaging is recommended. We suggest staged treatment with initial stabilisation in a Halo body jacket and early fusion for those with unstable injuries, severe displacement or neurological involvement.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General