Internal fixation without fusion of a flexion-distraction injury in the lower cervical spine of a three-year-old

Background context: Reported surgical treatment of unstable pediatric cervical spine injuries typically involves posterior fusion with internal fixation, usually with posterior wiring. Purpose: To discuss management issues in the treatment of an unstable Salter-Harris type I pediatric cervical spine injury and surgical intervention without fusion. Study design: A case report. Methods: Summary of the management of an unstable flexion-distraction injury in a 3-year-old child is presented with literature review. Results: A rare unstable flexion distraction injury of the pediatric cervical spine was successfully treated with posterior wiring without fusion. The wires underwent fatigue failure and maintenance of motion achieved without instability at 2-year follow-up. Conclusions: In select physeal injuries of the pediatric cervical spine, internal fixation can provide stability while healing occurs, with avoidance of fusion and maintenance of motion.