• Alwyn Jones, Jwalant Mehta, Dan Fagan, Sashin Ahuja, Andrew Grant, and Paul Davies.
• University of Wales Hospital, Heath Park, Cardiff, Wales. alwyn.j@virgin.net
• Spine. 2005 Jan 1; 30 (1): E28-30.

Study DesignA case of an odontoid nonunion in a child treated with anterior screw fixation.ObjectivesTo demonstrate that an anterior screw procedure can be performed with an odontoid nonunion with resultant fusion to maintain range of motion.MethodsA 15-year-old boy presented with pain in his neck following a rugby football injury. Admission plain radiographs and computed tomography scan demonstrated an odontoid nonunion. Radiographs of a previous cervical spine injury 2 years before demonstrated a missed odontoid fracture.ResultsThe child was initially treated conservatively with halo vest immobilization, which did not result in healing. Direct anterior screw fixation was performed and the fracture united 5 months following surgery.DiscussionThe nonunion was asymptomatic for 2 years until the second injury when it became clinically symptomatic. It did not respond to conservative treatment and was unstable on screening requiring operative intervention.ConclusionsVery few cases have been reported of pediatric odontoid nonunions. If the fracture pattern allows, then direct anterior screw fixation should be considered in order to maintain range of motion at the atlantoaxial articulation.

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