Open mouth digital reduction of an odontoid synchondrosis fracture: a case report

The "odontoid synchondrosis fracture" represents a rare but typical injury of the upper cervical spine in children less than 7 years. Conservative treatment with closed reduction and external fixation shows fusion rates across the synchondrosis in about 90% cases. When closed reduction cannot be achieved, open reduction and internal fixation is usually performed. We present the case of a girl aged 3 years and 5 months, whose closed reduction by passive manipulation of the head failed, but the same could successfully be achieved through transoral manipulation of the dens. After treatment with a Minerva plaster cast, the fracture was healed without complication. We suggest transoral manipulation in cases of otherwise irreducible "odontoid synchondrosis fracture." This technical hint may avoid unnecessary surgery in children with this type of injury.