Temporary atlantoaxial wiring without fusion for a displaced odontoid synchondrotic disruption'

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Temporary atlanto-axial wiring without fusion for
a displaced odontoid synchondrotic disruption.

• Hossam Salah MD FRCS(Eng)
• Orthopaedic department
• Cairo University

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Introduction

• Displaced odontoid fractures in young children
  are mostly treated non-operatively. C1/C2 fusion
  has occasionally been reported for those who fail
  with nonoperative measures.

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Presentation

• SRA a two year old girl was involved in a RTA and
  sustained a displaced synchondrotic disruption of
  the odontoid. She was neurologically intact. An
  attempted gentle manipulation and a Minerva cast
  failed to maintain the odontoid in a reduced
  position.

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Imaging
Odontoid synchondrosis disruption. Note the
rotation at C1/C2 on axial CT.
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Imaging
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Operative procedure

• She was therefore operated upon with
  extra-periosteal dissection of C1 and C2 and a
  sublaminar Titanium cable inserted fixing C1/C2.
  A paediatric hard collar was then applied. Two
  months later, the cable was removed to restore
  C1/C2 motion.

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Immediate postop x-rays
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12 months post removal
Flexion/extension images show movement at C1/C2.
Odontoid healed with no movement detected.
Clinically, the patient maintains normal cervical
rotation. She is able to touch shoulders with
chin on both sides.
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Conclusions

• Temporary stabilization of the atlanto-axial
  joint can be an option in the management of
  displaced odontoid fractures in young children
  when a Minerva cast fails to maintain the
  reduction. Strict extra-periosteal dissection and
  early removal of the cable can prevent C1/C2
  fusion.

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Thank you