{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:42:31Z","timestamp":1787755351147,"version":"build-2784847793"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JBJS Case Connector"],"abstract":"\n Case:<\/jats:title>\n Spine injuries are rare in children, but when they do occur, the synchondrosis of C2 may be involved. A 5-year-old boy presented to our clinic complaining of neck pain for 6 weeks, which started after wrestling with peers. He had slight upper extremity weakness, clonus, and diminished reflexes. Imaging, including computed tomography and magnetic resonance imaging scans, showed a fracture dislocation through the synchondrosis of the odontoid. The patient was initially treated with admission to the hospital, awake halo placement, and gradual traction over a few days. Subsequently, he was taken for transoral reduction and posterior instrumented fusion of C1-C3 using a combination of sublaminar suture, screws, and rods. Most recently, he was doing well over 2 years later, with no residual neurologic symptoms.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n The case presented demonstrates one option for an otherwise nonreducible odontoid synchondrosis fracture with complete atlantoaxial dislocation: transoral reduction and open posterior instrumentation. This proved to be a practical technique and provided a good clinical result in this case. These injuries are rare, but when they do occur, the examination can be surprisingly subtle given the severity of the injury. Plain films should be scrutinized carefully and advanced imaging obtained when necessary to confirm the diagnosis.<\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.cc.18.00327","type":"journal-article","created":{"date-parts":[[2019,6,11]],"date-time":"2019-06-11T21:02:03Z","timestamp":1560286923000},"page":"e0327-e0327","source":"Crossref","is-referenced-by-count":5,"title":["Complete Atlantoaxial Dislocation After Odontoid Synchondrosis Fracture: A 2-Year Follow-up Study"],"prefix":"10.2106","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0512-6019","authenticated-orcid":false,"given":"Brian A.","family":"Karamian","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0232-356X","authenticated-orcid":false,"given":"Sean T.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4328-562X","authenticated-orcid":false,"given":"Lawrence A.","family":"Rinsky","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,4]]},"reference":[{"key":"bib1-20230712","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1053\/jpsu.2001.25665","article-title":"Cervical spine injuries in children: a review of 103 patients treated consecutively at a level 1 pediatric trauma center","volume":"36","author":"Brown","year":"2001","journal-title":"J Pediatr Surg."},{"key":"bib2-20230712","first-page":"1","article-title":"Cervical spine trauma in children: a review","volume":"20","author":"McCall","year":"2006","journal-title":"Neurosurg Focus."},{"key":"bib4-20230712","doi-asserted-by":"crossref","first-page":"1882","DOI":"10.3174\/ajnr.A3105","article-title":"Normal ossification patterns of atlas and axis: a CT study","volume":"33","author":"Karwacki","year":"2012","journal-title":"AJNR Am J Neuroradiol."},{"key":"bib5-20230712","doi-asserted-by":"crossref","first-page":"921","DOI":"10.2106\/00004623-197860070-00008","article-title":"Fractures of the odontoid process in young children","volume":"60","author":"Sherk","year":"1978","journal-title":"J Bone Joint Surg Am."},{"key":"bib6-20230712","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.3171\/foc.2006.20.2.8","article-title":"Odontoid synchondrosis fractures in children","volume":"20","author":"Fassett","year":"2006","journal-title":"Neurosurg Focus."},{"key":"bib7-20230712","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1097\/01241398-199901000-00012","article-title":"Fractures of the odontoid process: a report of 15 cases in children younger than 6 years","volume":"19","author":"Odent","year":"1999","journal-title":"J Pediatr Orthop."},{"key":"bib8-20230712","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1302\/0301-620X.91B6.22173","article-title":"Fractures of the odontoid in children with an open basilar synchondrosis","volume":"91","author":"Hosalkar","year":"2009","journal-title":"J Bone Joint Surg Br."},{"key":"bib9-20230712","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1007\/s00247-014-3224-5","article-title":"New C2 synchondrosal fracture classification system","volume":"45","author":"Rusin","year":"2015","journal-title":"Pediatr Radiol."},{"key":"bib10-20230712","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/BF00307830","article-title":"Fractures of the odontoid process in small children: biomechanical analysis and report of three cases","volume":"5","author":"Blauth","year":"1996","journal-title":"Eur Spine J."},{"key":"bib11-20230712","doi-asserted-by":"crossref","first-page":"35","DOI":"10.3171\/2011.10.PEDS11256","article-title":"Open reduction and internal fixation for angulated, unstable odontoid synchondrosis fractures in children: a safe alternative to halo fixation?","volume":"9","author":"Fulkerson","year":"2012","journal-title":"J Neurosurg Pediatr."},{"key":"bib12-20230712","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1007\/s00381-015-2821-4","article-title":"Successful delayed non-operative management of C2 neurosynchondrosis fractures in a pediatric patient: a case report and review of management strategies and considerations for treatment","volume":"32","author":"Shammassian","year":"2016","journal-title":"Childs Nerv Syst."},{"key":"bib13-20230712","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1097\/BPO.0b013e3181cefe45","article-title":"Open mouth digital reduction of an odontoid synchondrosis fracture: a case report","volume":"30","author":"Huber","year":"2010","journal-title":"J Pediatr Orthop."},{"key":"bib14-20230712","doi-asserted-by":"crossref","first-page":"e78","DOI":"10.2106\/JBJS.CC.16.00105","article-title":"Fractures of the bilateral C2 neurocentral and lateral dental synchondroses with kyphotic C1-C2 subluxation in a 3-year-old girl: a description of a rare fracture pattern and its treatment: a case report","volume":"7","author":"Gautier","year":"2017","journal-title":"JBJS Case Connect."},{"key":"bib15-20230712","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1227\/00006123-198603000-00008","article-title":"Experience in the management of odontoid process injuries: an analysis of 128 cases","volume":"18","author":"Dunn","year":"1986","journal-title":"Neurosurgery."},{"key":"bib16-20230712","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1111\/j.1445-2197.1978.tb00049.x","article-title":"Some specific anatomical features of the atlas and axis: dens, epitransverse process and articular facets","volume":"48","author":"Tulsi","year":"1978","journal-title":"Aust N Z J Surg."},{"key":"bib17-20230712","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.nec.2007.04.005","article-title":"Congenital anomalies of the cervical spine","volume":"18","author":"Klimo","year":"2007","journal-title":"Neurosurg Clin N Am."}],"container-title":["JBJS Case Connector"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01709767-201906000-00017","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:41:44Z","timestamp":1787751704000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01709767-201906000-00017"}},"subtitle":["A Case Report"],"short-title":[],"issued":{"date-parts":[[2019,4]]},"references-count":16,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.cc.18.00327","relation":{},"ISSN":["2160-3251"],"issn-type":[{"value":"2160-3251","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4]]}}}