Comparative Analysis of Surgical Fixation Techniques for Pediatric Odontoid Fractures: A Systematic Review.

Abstract

This review evaluates anterior, posterior, and combined fixation techniques for pediatric odontoid fractures, addressing the lack of comparative data on outcomes and complications. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-based review identified 1,497 studies, with eight meeting inclusion criteria after screening. Studies were assessed for quality using the Joanna Briggs Institute checklist, and data on demographics, fracture types, surgical techniques, fusion rates, and complications were analyzed. Among 62 pediatric cases, posterior approaches were the most common (66.1%), followed by anterior approaches (27.4%) and combined approaches (6.5%). Fusion rates were highest with combined approaches (100%), followed by the posterior approach (92.7%) and the anterior approach (88.2%). However, the posterior approach had the highest complication rate (43.9%), including infections, persistent symptoms, and failed fusion. Combined approaches demonstrated superior outcomes with no complications, whereas anterior techniques, although effective in select cases, resulted in one mortality. This review highlights the superior outcomes of combined approaches for complex pediatric odontoid fractures, achieving 100% fusion with no complications. Posterior techniques remain reliable, but advancements in technique and postoperative care are necessary to reduce complications further. High-quality, multicenter studies are crucial for establishing standardized management protocols and evaluating long-term outcomes.