title: Anterior screw fixation for a pediatric odontoid nonunion: a case report.
abstract: METHODS
  A case of an odontoid nonunion in a child treated with anterior screw fixation.
  
  
  OBJECTIVE
  To demonstrate that an anterior screw procedure can be performed with an odontoid nonunion with resultant fusion to maintain range of motion.
  
  
  METHODS
  A 15-year-old boy presented with pain in his neck following a rugby football injury. Admission plain radiographs and computed tomography scan demonstrated an odontoid nonunion. Radiographs of a previous cervical spine injury 2 years before demonstrated a missed odontoid fracture.
  
  
  RESULTS
  The child was initially treated conservatively with halo vest immobilization, which did not result in healing. Direct anterior screw fixation was performed and the fracture united 5 months following surgery.
  
  
  CONCLUSIONS
  The nonunion was asymptomatic for 2 years until the second injury when it became clinically symptomatic. It did not respond to conservative treatment and was unstable on screening requiring operative intervention.
  
  
  CONCLUSIONS
  Very few cases have been reported of pediatric odontoid nonunions. If the fracture pattern allows, then direct anterior screw fixation should be considered in order to maintain range of motion at the atlantoaxial articulation.
authors.affiliation: University of Wales Hospital, Heath Park, Cardiff, Wales. alwyn.j@virgin.net
authors.forename: Alwyn
authors.initials: A
authors.lastname: Jones
authors.forename: Jwalant
authors.initials: J
authors.lastname: Mehta
authors.forename: Dan
authors.initials: D
authors.lastname: Fagan
authors.forename: Sashin
authors.initials: S
authors.lastname: Ahuja
authors.forename: Andrew
authors.initials: A
authors.lastname: Grant
authors.forename: Paul
authors.initials: P
authors.lastname: Davies
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D005538:Football / Q000293:injuries; D006801:Humans; D008297:Male; D009809:Odontoid Process / Q000293:injuries* / Q000502:physiology*; D016059:Range of Motion, Articular; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome