Odontoid fractures in the pediatric population: a systematic review and management algorithm.

IF 1.3 4区 医学 Q3 ORTHOPEDICS Journal of Childrens Orthopaedics Pub Date : 2024-09-19 eCollection Date: 2024-10-01 DOI:10.1177/18632521241283232
Anjali M Prabhat, David S Liu, Lara Cohen, Daniel Gabriel, Kristen E Hines, Grant D Hogue
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Abstract

Purpose: The management of odontoid fractures in adult patients has been widely described. However, there is sparse literature about this injury in the pediatric population. This study aimed to review published literature regarding the management and outcomes of pediatric odontoid fractures to develop a stepwise treatment algorithm.

Methods: A literature review was conducted using PRISMA guidelines on PubMed to identify studies between 1960 and 2023 that reported on the management and outcomes of odontoid fracture in pediatric patients. Studies were included if they were published in English and if their sample included at least four patients aged 0-18, minimum follow-up of 6 weeks, and outcomes for each patient clearly differentiated.

Results: In total, 15 studies including 125 pediatric patients with odontoid fractures were included. Treatment options varied from non-operative management with immobilization in rigid collars, halo vests, cervicothoracic orthosis, or soft collars to surgical management with fixation and/or arthrodesis. There were 73 patients initially treated nonoperatively, 47 initially treated surgically, 2 who healed with observation alone, and 3 who died acutely of concomitant injuries. The nonunion rate for nonoperative management was 5.5%. Surgery was successful, demonstrating bony union at final follow-up, in 94.6% of cases treated via a posterior approach and 85.7% of cases treated with an anterior approach.

Conclusions: Odontoid fractures must be considered in pediatric patients with cervical spine trauma. This is the largest literature review of pediatric odontoid fractures. Various management strategies exist and can be considered. The proposed algorithm offers an evidence-based framework for the management of pediatric odontoid fractures.

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小儿牙槽骨骨折:系统回顾和处理算法。
目的:成人患者蝶骨骨折的治疗方法已被广泛描述。然而,关于小儿患者这种损伤的文献却很少。本研究旨在回顾已发表的有关小儿寰枢椎骨折的治疗和结果的文献,以制定一个循序渐进的治疗算法:方法:采用PRISMA指南在PubMed上进行文献综述,以确定1960年至2023年间有关小儿蝶骨骨折的治疗和结果的研究。如果研究是用英语发表的,且样本中至少有四名0-18岁的患者,随访时间至少为6周,并对每名患者的治疗结果进行了明确区分,则可纳入研究:结果:共纳入15项研究,包括125名蝶骨骨折的儿科患者。治疗方案多种多样,从使用硬袢固定、晕背心、颈胸椎矫形器或软袢固定的非手术治疗,到使用固定和/或关节置换术的手术治疗。最初接受非手术治疗的患者有 73 人,最初接受手术治疗的患者有 47 人,仅通过观察就痊愈的患者有 2 人,因并发症急性死亡的患者有 3 人。非手术治疗的不愈合率为 5.5%。94.6%的病例通过后路手术治疗成功,85.7%的病例通过前路手术治疗成功,并在最后随访时显示骨结合:结论:对于颈椎外伤的儿科患者,必须考虑到齿状突骨折。这是关于小儿蝶骨骨折的最大规模的文献综述。有多种治疗策略可供参考。建议的算法为小儿寰枢椎骨折的治疗提供了循证框架。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Childrens Orthopaedics
Journal of Childrens Orthopaedics Medicine-Orthopedics and Sports Medicine
CiteScore
2.70
自引率
14.30%
发文量
61
审稿时长
23 weeks
期刊介绍: Aims & Scope The Journal of Children’s Orthopaedics is the official journal of the European Paediatric Orthopaedic Society (EPOS) and is published by The British Editorial Society of Bone & Joint Surgery. It provides a forum for the advancement of the knowledge and education in paediatric orthopaedics and traumatology across geographical borders. It advocates an increased worldwide involvement in preventing and treating musculoskeletal diseases in children and adolescents. The journal publishes high quality, peer-reviewed articles that focus on clinical practice, diagnosis and treatment of disorders unique to paediatric orthopaedics, as well as on basic and applied research. It aims to help physicians stay abreast of the latest and ever-changing developments in the field of paediatric orthopaedics and traumatology. The journal welcomes original contributions submitted exclusively for review to the journal. This continuously published online journal is fully open access and will publish one print issue each year to coincide with the EPOS Annual Congress, featuring the meeting’s abstracts.
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