Most odontoid fractures in children (<8 years old) are through the synchondro-sis between the odontoid process and vertebral body. These are usually treated with halo-ring and vest immobilization, and rarely with surgical fusion. The majority of children suffer spinal-column injury alone and are therefore neurologically intact. Older children and adolescents may suffer from a traditional "Type II" odontoid fracture at the narrow base of the dens and are treated similarly to adults, with cervical collar, halo immobilization, or internal fixation with an odontoid screw. Pathological C1-2 subluxation secondary to disruption of the transverse ligament, which normally holds the odontoid against the anterior arch of C1, is generally treated by open C1-2 fusion.
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