In contrast to the literature, we do not recommend a permanent posterior fusion of C1/C2. The posterior fixation wire was removed after 5 months. After a temporary posterior fixation of C1/C2 we reamed the synchondrosis from anterior and performed autogenous bone grafting. In our second case, despite an anatomic reduction, the odontoid fracture failed to unite. In one case, in which the anterior dislocation was less than the diameter of the odontoid shaft, eventless healing occurred. After closed reduction, both cases were initially trated conservatively with halo and plaster vest for 12 weeks. Neither child had neurological deficit, which correlates well with the literature, where neurological injuries were found only in conjunction with head injuries. Both children were immediately symptomatic, and the diagnosis was obvious on radiographs. Shearing force is all that is necessary to explain the dens fracture. This revealed that head-on collisions with a speed absorption of at least 40 km/h are the typical mechanism of injury in children under the age of 3 years involved in motor vehicle accidents. A biomechanical investigation was carried out using simulation in a real car crash test with a child dummy. ![]() We report two cases in which 2-year-old children were involved as backseat passengers in head-on motor vehicle accidents, both were restrained by four-point child's seat harnesses. Odontoid “fractures” in young children typically involve the cartilaginous plate (synchondrosis) that separates the odontoid process from the body of the axis 58 cases have been described in the literature.
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