Elsevier

Neurologia i Neurochirurgia Polska

Volume 52, Issue 5, September–October 2018, Pages 618-622
Neurologia i Neurochirurgia Polska

Original research article
Treatment of the dens fractures in children

https://doi.org/10.1016/j.pjnns.2018.08.007Get rights and content

Abstract

The anatomical and biomechanical features of the immature cervical spine make the upper segments at C1–3 especially susceptible to injury.

Material and method

From 2000 to 2016, 10 patients (3 boys, 7 girls) with C2 dens fractures were treated. The average age of each child was 11 years (3–17). According to the Anderson classification, there were 6 patients with a type III fracture and 4 with a type II. 4 patients were treated conservatively using the Minerva cervical brace for 75 days (66–125) and 6 patients by means of the Halo-Vest for 79 days (64–87) and followed by the Schantz collar for 17 days (2–35).

Results

The follow up lasted 78 months (12–180). The NDI (Neck Disability Index) score was calculated for each patient, except for section 8 (driving the car). The scores ranged from 1/45 (2.22%) to 20/45 (44.44%). The mean score for 9 out of the 10 patients (one patient died) was 4.77 (10.61%).

Conclusion

The C2 dens fracture is a rare injury in children. The classification system of dens fractures developed by Anderson is useful in choosing the mode of treatment of dens fractures.

Section snippets

Background

Upper cervical spine injuries are associated with high energy and are frequently fatal. Children appear to be at increased risk of injury at this site [[1], [2], [3], [4]]. The injury frequently leads to severe cord and brain-stern injury, causing respiratory arrest. Increasingly, however, there have been reports of patients surviving this injury and even patients with upper cervical fractures with intact neurological function have been documented [5]. 2–3% of all cervical spinal injuries are

Material and method

From 2000 to 2016, 10 patients with C2 dens fractures were treated. It is a retrospective work consisting in the data analysis of the dens fractures treatment in children, the approval of the ethical committee was not required for this study. The parents have been informed that their child's disease will be included in scientific paper. There were 3 boys and 7 girls. The mean age was 11 years (3–17).

The fractures were caused by a traffic accident in 4 of the cases, a fall in 3 cases and sport

Results

The follow up was 78 months (12–180). If the child had no neck pain or cervical spine tenderness and had a full, painless range of motion of the neck and spine, then the cervical brace orthosis was removed. The patient’s range of motion was evaluated only when they were conscious and cooperative. After ablation of the brace, anteroposterior and lateral radiographs with voluntary flexion and extension of the cervical spine were used in 9 patients (1 patient being a non-cooperative patient).

Discussion

Children with injuries to the cervical spine present a great challenge for medical facilities. In addition, a child presents challenges in assessment, imaging, and both operative and nonoperative management [4]. There are very few papers about pediatric C2 dens fractures, especially fractures with no neurological deficit. The goal of the C2 dens fracture is the return of maximum functional ability, minimal residual pain, decrease of any neurological deficit, minimal residual deformity and

Conclusion

  • 1

    The C2 dens fracture rarely occurs in children.

  • 2

    The diagnostic method for C2 dens is CT-scan, MRI and X-ray evaluation.

  • 3

    The classification system of dens fractures developed by Anderson is useful in choosing the mode of treatment of the dens fractures.

  • 4

    The Halo-Vest is a good method for treating unstable C2 dens fractures.

Conflict of interest

None declared.

Acknowledgement and financial support

None declared.

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