Displaced odontoid synchondrosis fracture with C1-2 dysjunction in an 18-month-old child: challenges and solutions

Background Odontoid synchondral fractures in very young children with displacement/angulation are highly unstable and require surgical intervention. Soft and small bones with poor pull-out strengths make instrumentation and manipulation difficult. Case report We report an 18-month-old child with such a fracture where minimal traction made C1–2 dysjunction apparent with neurological worsening. The C1–2 facets were fixed with a short plate and facetal screws. The child had a good outcome. Conclusion Traction should be applied cautiously to avoid distraction injuries. Careful intraoperative manipulation should be planned to avoid any pull outs/fractures while realigning the spine and fixing it.