Complete Atlantoaxial Dislocation After Odontoid Synchondrosis Fracture: A 2-Year Follow-up Study

Case: Spine injuries are rare in children, but when they do occur, the synchondrosis of C2 may be involved. A 5-year-old boy presented to our clinic complaining of neck pain for 6 weeks, which started after wrestling with peers. He had slight upper extremity weakness, clonus, and diminished reflexes. Imaging, including computed tomography and magnetic resonance imaging scans, showed a fracture dislocation through the synchondrosis of the odontoid. The patient was initially treated with admission to the hospital, awake halo placement, and gradual traction over a few days. Subsequently, he was taken for transoral reduction and posterior instrumented fusion of C1-C3 using a combination of sublaminar suture, screws, and rods. Most recently, he was doing well over 2 years later, with no residual neurologic symptoms. Conclusions: The case presented demonstrates one option for an otherwise nonreducible odontoid synchondrosis fracture with complete atlantoaxial dislocation: transoral reduction and open posterior instrumentation. This proved to be a practical technique and provided a good clinical result in this case. These injuries are rare, but when they do occur, the examination can be surprisingly subtle given the severity of the injury. Plain films should be scrutinized carefully and advanced imaging obtained when necessary to confirm the diagnosis.