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Review
. 2025 Jul 27;17(7):e88866.
doi: 10.7759/cureus.88866. eCollection 2025 Jul.

Comparative Analysis of Surgical Fixation Techniques for Pediatric Odontoid Fractures: A Systematic Review

Razan Zantout  1 , Imad Ashkar  1 , Rawan Masarwa  2 , Kawthar El Khatib  1 , Reem Aldanaf  1 , Sam Najjar  1 , Carelle Karam  1 , Rebecca Bou Kanj  1 , Alain El Marji  1 , Neel Badhe  3 , Chinedu Egu  2 , Elie Najjar  2
Affiliations
Review

Comparative Analysis of Surgical Fixation Techniques for Pediatric Odontoid Fractures: A Systematic Review

Razan Zantout et al. Cureus. .

Abstract

This review evaluates anterior, posterior, and combined fixation techniques for pediatric odontoid fractures, addressing the lack of comparative data on outcomes and complications. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-based review identified 1,497 studies, with eight meeting inclusion criteria after screening. Studies were assessed for quality using the Joanna Briggs Institute checklist, and data on demographics, fracture types, surgical techniques, fusion rates, and complications were analyzed. Among 62 pediatric cases, posterior approaches were the most common (66.1%), followed by anterior approaches (27.4%) and combined approaches (6.5%). Fusion rates were highest with combined approaches (100%), followed by the posterior approach (92.7%) and the anterior approach (88.2%). However, the posterior approach had the highest complication rate (43.9%), including infections, persistent symptoms, and failed fusion. Combined approaches demonstrated superior outcomes with no complications, whereas anterior techniques, although effective in select cases, resulted in one mortality. This review highlights the superior outcomes of combined approaches for complex pediatric odontoid fractures, achieving 100% fusion with no complications. Posterior techniques remain reliable, but advancements in technique and postoperative care are necessary to reduce complications further. High-quality, multicenter studies are crucial for establishing standardized management protocols and evaluating long-term outcomes.

Keywords: odontoid; odontoid fractures; pediatrics; surgical fixation; surgical outcomes.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Anderson and D’Alonzo classification of odontoid fractures
Image Credit: Authors
Figure 2
Figure 2. PRISMA flowchart
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
See this image and copyright information in PMC

References

    1. Epidemiology of spinal fractures in children: Cross-sectional study. Compagnon R, Ferrero E, Leroux J, et al. Orthop Traumatol Surg Res. 2020;106:1245–1249. - PubMed
    1. Odontoid fractures in the pediatric population: a systematic review and management algorithm. Prabhat AM, Liu DS, Cohen L, Gabriel D, Hines KE, Hogue GD. J Child Orthop. 2024;18:486–494. - PMC - PubMed
    1. C2 Synchondrosal Injuries: A Case Report and Anatomic Review. Nwachukwu C, Wang W, Soule E, Pirmoazen A, Fiester P. Cureus. 2023;15:0. - PMC - PubMed
    1. Surgical Treatment for Displaced Odontoid Synchondrosis Fracture: A Retrospective Case Series Study. Gao S, Xun C, Xu T, et al. Global Spine J. 2024;14:1937–1943. - PMC - PubMed
    1. Fractures of the odontoid process in small children: biomechanical analysis and report of three cases. Blauth M, Schmidt U, Otte D, Krettek C. Eur Spine J. 1996;5:63–70. - PubMed

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