New C2 Synchondrosal Fracture Classification System

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Pediatric Radiology

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Background. Excessive cervical flexion-extension accompanying mild to severe impact injuries can lead to C2 synchondrosal fractures in young children. Objective. To characterize and classify C2 synchondrosal fracture patterns. Materials and Methods. We retrospectively reviewed imaging and medical records of children who had cervical spine fractures at our institution between 1995 and 2014. All fractures involving the 5 central C2 synchondroses were selected and reviewed with regard to patient demographics, mechanism of injury, fracture pattern, associated fractures/injuries, treatment plans and outcome. Results. Fourteen fractures involved the central C2 synchondroses. There were 9 males and 5 females, all less than 6 years old. There were 4 distinct fracture patterns. Eleven complete fractures were further subdivided into 4 subtypes (a-d) based on degree of anterior displacement of the odontoid segment and presence of distraction. Nine patients had fractures through both odontoneural synchondroses and the odontocentral synchondrosis. One patient had fractures involving both neurocentral synchondroses and the odontoneural synchondrosis. One patient had fractures through bilateral odontoneural and neurocentral synchondroses. Three patients had incomplete fractures defined as a fracture through a single odontoneural synchondrosis with or without partial extension into either the odontocentral or the adjacent neurocentral synchondrosis. All complete fractures were displaced or angulated. Four had associated spinal cord injury: 2 contusions (subtype c fractures and 2 fatal transections subtype d fractures). Most of the 11 surviving patients were treated with primary halo stabilization. Subtype c fractures required surgical fixation. Conclusions. We describe 4 patterns of central C2 synchondrosal fractures, including 2 patterns not previously reported. We propose a classification system to distinguish these fractures and aid treatment planning.


Health Professions - Clinical (The Ohio State University Denman Undergraduate Research Forum)


Radiology, C2, Pediatrics, Cervical Spine, Fracture


Rusin, Jerome A., Lynne Ruess, and Robert S. Daulton. "New C2 synchondrosal fracture classification system." Pediatric radiology (2014): 1-10.