Successful Non-fusion Management of a Healed Pediatric Odontoid Synchondrosis Fracture: A Case Report.

Odontoid synchondrosis fractures are rare pediatric spinal injuries that pose significant diagnostic and treatment challenges. These fractures, typically occurring in the C-2 vertebra, often result from high-energy trauma and are difficult to diagnose due to subtle radiographic findings. We present the case of a 4-year-old male who sustained a head injury while playing on a trampoline. Initially diagnosed with a head injury and discharged without noting any neck complaints, the patient returned to the ER two months later with neck pain and stiffness. Radiographs revealed a C2 fracture at the base of the odontoid process, confirmed by CT and MRI scans. The patient underwent open reduction and HALO fixation to manage the displaced sub-dental synchondrosis fracture. The patient was admitted to the operating room for reduction and immobilization under general anesthesia. After an unsuccessful closed reduction attempt, an open reduction was performed followed by the application of a HALO vest. Postoperative care included follow-up appointments at 6 weeks, 12 weeks, and 16 months, which showed good alignment, significant bone union, and complete fracture healing. At the most recent check-up, six years post-injury, the patient demonstrated full neck mobility without pain or neurological symptoms. This case highlights the successful management of a pediatric odontoid synchondrosis fracture with non-fusion treatment. Even with delayed intervention, appropriate and timely treatment led to excellent outcomes, ensuring proper healing and preserving the functional mobility of the cervical spine. This underscores the importance of thorough initial assessment and the potential for successful non-fusion treatment strategies in pediatric cervical spine injuries.