Treatment of the dens fractures in children

Abstract

The anatomical and biomechanical features of the immature cervical spine make the upper segments at C1-3 especially susceptible to injury.

Material and method: From 2000 to 2016, 10 patients (3 boys, 7 girls) with C2 dens fractures were treated. The average age of each child was 11 years (3-17). According to the Anderson classification, there were 6 patients with a type III fracture and 4 with a type II. 4 patients were treated conservatively using the Minerva cervical brace for 75 days (66-125) and 6 patients by means of the Halo-Vest for 79 days (64-87) and followed by the Schantz collar for 17 days (2-35).

Results: The follow up lasted 78 months (12-180). The NDI (Neck Disability Index) score was calculated for each patient, except for section 8 (driving the car). The scores ranged from 1/45 (2.22%) to 20/45 (44.44%). The mean score for 9 out of the 10 patients (one patient died) was 4.77 (10.61%).

Conclusion: The C2 dens fracture is a rare injury in children. The classification system of dens fractures developed by Anderson is useful in choosing the mode of treatment of dens fractures.

Keywords: Children; Dens fractures; Halo-Vest; Spinal cord; Treatment.