Sublaminar wiring for odontoid synchondrotic fracture stabilization in a 4-year-old: a case report

Abstract

Background: The pediatric age group presents a challenge in diagnosis and management of upper cervical injuries. Cervical spine injuries are relatively rare in children as compared to adults and C2 vertebra is the commonly affected site for fracture and injury.

Methods: In our case, a 4-year-old female child was brought to the emergency after being hit over the head and neck by a falling wooden beam. Patient had associated minimal neurological deficits. Urgent CT scan of the head and cervical spine were done. CT spine suggested instability as there was anterior angulation of the odontoid process with anterior displacement and associated occipital fracture. Patient underwent a sublaminar wiring at C1-C2 vertebra.

Results: There was neurological improvement following surgery and patient was discharged after 2 weeks on soft cervical collar. Synchondrotic odontoid fracture is traditionally managed with closed reduction and external stabilization due to high rates of fusion in children.

Conclusions: However, early surgical intervention has an important role in management of unstable injuries. Sublaminar wiring though not as stable as rigid instrumentation can be done in pediatric patients where even the smallest instrumentation is too invasive. Management of the odontoid synchondrosis fracture remains a controversial topic in children of younger age group.

Keywords: Craniocervical ligament injury; Odontoid fracture; Pediatric cervical injuries; Sublaminar wiring; Synchondrotic slip.