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Conservative management of odontoid fracture in a 20-month old: case report
EANS Academy. Churi O. 09/25/19; 275786; EP06010
Omkar Churi
Omkar Churi

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Introduction: Odontoid process fractures represent an uncommon injury in small children, with their optimal management remaining unclear. We present a case of a 20-month old with a type II odontoid fracture with significant anterior displacement and a 60-degree angulation following a road traffic accident.
Case: The child was involved in a serious road traffic accident as a backseat passenger a week before presentation. At presentation post-incident, she was reluctant to move her neck and kept it flexed. She did not have any history suggestive of cranial injury and had no neurological deficit in her limbs. A CT cervical spine revealed a type II odontoid fracture with significant displacement of odontoid and anterior angulation. The child was started on analgesia and muscle relaxants. A cervical collar was applied and the child was taken to the theatre for application of a Halo-vest. The child tolerated the vest very well. The halo was kept for 12 weeks with serial imaging suggestive of better alignment of the occipito-atlanto-axis.
Discussion: High velocity trauma is the most common mode of injury for odontoid fracture in paediatric population. It depicts the difficulties in diagnosis as symptoms cannot be obtained from the patient. Studied in detail in the adults, the management of such fractures in children remains unclear.
Conclusion: Clinicians should maintain a high index of suspicion in a child, who has a significant mechanism of injury, and is distressed with movement of the neck. There is very little literature on this topic whether instrumented intervention versus conservative management is best in aiding fracture union and functional outcome in the small child.
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