title: Complete Remodeling After Conservative Treatment of a Severely Angulated Odontoid Fracture in a Patient With Osteogenesis Imperfecta: A Case Report.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  This is the first case report describing successful healing and remodeling of a traumatic odontoid fracture that was dislocated and severely angulated in a patient with osteogenesis imperfecta who was treated conservatively.
  
  
  BACKGROUND
  Osteogenesis imperfecta (OI) is a rare genetic disorder resulting in a low bone mass and bone fragility, predisposing these patients to fractures that often occur at a young age. Although any bone in the body may be involved, odontoid fractures are uncommon in this population. Because of a very high fusion rate, conservative management is accepted as a safe and efficient treatment of fractures of the odontoid in children. Several authors, however, recommend surgical treatment of patients who have failure of conservative treatment and have severe angulation or displacement of the odontoid.
  
  
  METHODS
  A 5-year-old female, diagnosed with OI type I, presented with neck pain without any neurological deficits after falling out of a rocking chair backward, with her head landing first on the ground. Computed tomography confirmed a type III odontoid fracture without dislocation and she was initially treated with a rigid cervical orthosis. At 1 and 2 months of follow-up, progressive severe angulation of the odontoid was observed but conservative treatment was maintained as the space available for the spinal cord was sufficient and also considering the patient's history of OI.
  
  
  RESULTS
  Eight months postinjury, she had no clinical symptoms and there was osseous healing of the fracture with remodeling of the odontoid to normal morphology.
  
  
  CONCLUSIONS
  Even in patients with OI, severely angulated odontoid fractures might have the capacity for osseous healing and complete remodeling under conservative treatment.
  
  
  METHODS
  5.
authors.affiliation: *Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands; and †Department of Orthopaedics, Juliana Children's Hospital, The Hague, the Netherlands.
authors.forename: Dino
authors.initials: D
authors.lastname: Colo
authors.forename: Tom P C
authors.initials: TP
authors.lastname: Schlösser
authors.forename: Hubert J
authors.initials: HJ
authors.lastname: Oostenbroek
authors.forename: René M
authors.initials: RM
authors.lastname: Castelein
mesh_terms: D000058:Accidental Falls; D016723:Bone Remodeling; D002675:Child, Preschool; D005260:Female; D017102:Fracture Healing; D006801:Humans; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D019637:Orthopedic Procedures / Q000295:instrumentation*; D009989:Orthotic Devices; D010013:Osteogenesis Imperfecta / Q000150:complications* / Q000175:diagnosis / Q000235:genetics / Q000503:physiopathology; D016103:Spinal Fractures / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome