{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T08:57:45Z","timestamp":1792659465078,"version":"4.5.0"},"reference-count":56,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2012,1]]},"abstract":"<jats:p>External orthosis is the accepted and historical management of odontoid synchondrosis fractures; however, this conservative therapy carries a significant complication and fracture nonunion rate among young children. The purpose of this study was to evaluate the authors' own experience in the context of the literature, to explore surgical fixation as a primary treatment for unstable fractures. The authors retrospectively reviewed 2 cases of unstable odontoid synchondrosis fractures treated at their institution; both showed radiographic progression of deformity and subsequently underwent an open surgical reduction and fusion. A literature review was conducted to compare the authors' management strategy with those in published data. External orthosis for treatment of odontoid synchondrosis fractures has a strong history of success. However, in the literature, patients treated with a halo orthosis had a 43.3% rate of complications and an 11.4% risk of nonunion. There are radiographic findings that suggest instability, such as severe angulation and displacement of the odontoid process. Both patients in the present report underwent successful fusion without complication, as documented on CT scans obtained 3 months after surgery. Given the high rate of fusion attained with conservative therapy, it is recommended for most synchondrosis fractures. However, there is a recognized subgroup of synchondrosis fractures with severe angulation (&gt; 30\u00b0) and displacement suggestive of significant ligamentous injury. In these patients, surgical fixation may be a safe and efficacious alternative to halo orthosis as the primary treatment.<\/jats:p>","DOI":"10.3171\/2011.10.peds11256","type":"journal-article","created":{"date-parts":[[2011,12,30]],"date-time":"2011-12-30T17:13:01Z","timestamp":1325265181000},"page":"35-41","source":"Crossref","is-referenced-by-count":30,"title":["Open reduction and internal fixation for angulated, unstable odontoid synchondrosis fractures in children: a safe alternative to halo fixation?"],"prefix":"10.3171","volume":"9","author":[{"given":"Daniel H.","family":"Fulkerson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven W.","family":"Hwang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akash J.","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Jea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0090035","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1007\/s00381-008-0607-7","article-title":"Fusions at the craniovertebral junction","volume":"24","author":"Ahmed","year":"2008"},{"key":"b2-0090035","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"1663","DOI":"10.2106\/00004623-197456080-00017","article-title":"Fractures of the odontoid process of the axis","volume":"56","author":"Anderson","year":"1974"},{"issue":"1 Suppl","key":"b3-0090035","series-title":"J Neurosurg","first-page":"55","article-title":"Long-term maintenance of cervical alignment after occipitocervical and atlantoaxial screw fixation in young children","volume":"105","author":"Anderson","year":"2006"},{"issue":"1 Suppl","key":"b4-0090035","series-title":"J Neurosurg","first-page":"36","article-title":"Selection of a rigid internal fixation construct for stabilization at the craniovertebral junction in pediatric patients","volume":"107","author":"Anderson","year":"2007"},{"key":"b5-0090035","series-title":"Rockwood and Green's Fractures in Adults","first-page":"1436","article-title":"Injuries of the craniocervical junction","volume":"1","author":"Bellabarba","year":"2005"},{"key":"b6-0090035","series-title":"Surgical Treatment of Orthopaedic Trauma","first-page":"101","article-title":"Injuries to the cervicocranium","author":"Bellabarba","year":"2007"},{"key":"b7-0090035","series-title":"Eur Spine J","doi-asserted-by":"publisher","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"},{"key":"b8-0090035","series-title":"Clin Orthop Relat Res","first-page":"12","article-title":"The halo skeletal fixator. 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