- 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.
