title: Sublaminar wiring for odontoid synchondrotic fracture stabilization in a 4-year-old: a case report.
abstract: BACKGROUND
  The pediatric age group presents a challenge in diagnosis and management of upper cervical injuries. Cervical spine injuries are relatively rare in children as compared to adults and C2 vertebra is the commonly affected site for fracture and injury.
  
  
  METHODS
  In our case, a 4-year-old female child was brought to the emergency after being hit over the head and neck by a falling wooden beam. Patient had associated minimal neurological deficits. Urgent CT scan of the head and cervical spine were done. CT spine suggested instability as there was anterior angulation of the odontoid process with anterior displacement and associated occipital fracture. Patient underwent a sublaminar wiring at C1-C2 vertebra.
  
  
  RESULTS
  There was neurological improvement following surgery and patient was discharged after 2 weeks on soft cervical collar. Synchondrotic odontoid fracture is traditionally managed with closed reduction and external stabilization due to high rates of fusion in children.
  
  
  CONCLUSIONS
  However, early surgical intervention has an important role in management of unstable injuries. Sublaminar wiring though not as stable as rigid instrumentation can be done in pediatric patients where even the smallest instrumentation is too invasive. Management of the odontoid synchondrosis fracture remains a controversial topic in children of younger age group.
authors.affiliation: Department of Neurosurgery, Sri Aurobindo Medical College & P.G Institute, Indore, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Neurosurgery, Sri Aurobindo Medical College & P.G Institute, Indore, India. sharad_jsr@yahoo.com.
authors.forename: Sharadendu
authors.identifier: http://orcid.org/0000-0002-4946-117X
authors.initials: S
authors.lastname: Narayan
mesh_terms: D002574:Cervical Vertebrae / Q000473:pathology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D009809:Odontoid Process / Q000601:surgery*; D019637:Orthopedic Procedures / Q000379:methods*; D016103:Spinal Fractures / Q000209:etiology / Q000628:therapy*; D013124:Spinal Injuries / Q000150:complications*; D014057:Tomography, X-Ray Computed; D014965:X-Rays
keywords: Craniocervical ligament injury; Odontoid fracture; Pediatric cervical injuries; Sublaminar wiring; Synchondrotic slip