Odontoid fractures in the pediatric population: a systematic review and management algorithm
Anjali M Prabhat1, David S Liu2, Lara Cohen2
1Harvard Medical School, Boston, MA, USA.
Insights
Pediatric odontoid fractures are rare but require careful management. This review of 125 cases suggests both surgical and non-surgical approaches can be effective, with surgery showing higher union rates.
Area of Science:
- Orthopedics
- Pediatric Traumatology
- Neurosurgery
Background:
- Odontoid fractures are well-documented in adults but underrepresented in pediatric literature.
- Accurate diagnosis and timely management are crucial for pediatric cervical spine trauma.
Purpose of the Study:
- To conduct a comprehensive literature review on the management and outcomes of pediatric odontoid fractures.
- To develop a stepwise treatment algorithm for pediatric odontoid fractures based on evidence.
Main Methods:
- A systematic literature review adhering to PRISMA guidelines was performed on PubMed.
- Studies published between 1960 and 2023, in English, with at least four pediatric patients (0-18 years) and a minimum 6-week follow-up were included.
Main Results:
- Fifteen studies comprising 125 pediatric patients were analyzed.
- Treatment options included non-operative (immobilization) and surgical (fixation/arthrodesis) methods.
- Nonunion rate for non-operative management was 5.5%; surgical union rates were 94.6% (posterior) and 85.7% (anterior).
Conclusions:
- Odontoid fractures are a significant concern in pediatric cervical spine injuries.
- A range of management strategies are available, with surgical intervention demonstrating high success rates.
- An evidence-based algorithm is proposed to guide the management of these fractures in children.
Purpose:
The management of odontoid fractures in adult patients has been widely described. However, there is sparse literature about this injury in the pediatric population. This study aimed to review published literature regarding the management and outcomes of pediatric odontoid fractures to develop a stepwise treatment algorithm.
Methods:
A literature review was conducted using PRISMA guidelines on PubMed to identify studies between 1960 and 2023 that reported on the management and outcomes of odontoid fracture in pediatric patients. Studies were included if they were published in English and if their sample included at least four patients aged 0-18, minimum follow-up of 6 weeks, and outcomes for each patient clearly differentiated.
Results:
In total, 15 studies including 125 pediatric patients with odontoid fractures were included. Treatment options varied from non-operative management with immobilization in rigid collars, halo vests, cervicothoracic orthosis, or soft collars to surgical management with fixation and/or arthrodesis. There were 73 patients initially treated nonoperatively, 47 initially treated surgically, 2 who healed with observation alone, and 3 who died acutely of concomitant injuries. The nonunion rate for nonoperative management was 5.5%. Surgery was successful, demonstrating bony union at final follow-up, in 94.6% of cases treated via a posterior approach and 85.7% of cases treated with an anterior approach.
Conclusions:
Odontoid fractures must be considered in pediatric patients with cervical spine trauma. This is the largest literature review of pediatric odontoid fractures. Various management strategies exist and can be considered. The proposed algorithm offers an evidence-based framework for the management of pediatric odontoid fractures.
