The Hip: Preservation, Replacement and Revision

Pediatric Dens Fracture

- See:
      - Adult Dens Frx:
      - Anatomy of C2:
      - Development of Dens:
      - Pediatric C-spine

- Discussion:
    - accounts for majority of pediatric C-spine frx (upto 75%)
    - in children, dens frx occur at an average age of 3-4 years & usually represent epiphyseal fracture thru the basilar synchondrosis;
    - basilar synchondrosis is fused by 6 years of age;
    - in children under age of 6 yrs, epiphysis may be present and may appear as a fracture at this level;

- Lateral Radiograph:
    - insist on lateral view centered at C2;
    - at C3 the retropharyngeal space should be less than 7 mm;
    - look for saggital displacement or rotation;

- Treatment:
    - avoid traction;
    - treated by reduction in recumbency w/ mild hyperextension followed by use of Minerva jacket or halo vest for 6-12 weeks;
         - placement of skull pins in children requires preoperative CT scan of skull to assess thickness;
         - it is recommended that six pins be inserted to finger tightness, which is about 2 in/lb of torque;

- Complications:
    - os odontoideum may be the adult equivalent of dens non union

Fractures of the odontoid process in young children.

Dysplasia of the odontoid process in Morquio's syndrome causing quadriparesis.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, December 22, 2011 3:46 pm