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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.