Fractures of the odontoid process are among the most common cervical injuries in preschool children, occurring at an average age of 4 years. These fractures are actually physeal injuries of the basilar synchondrosis between the odontoid process and the body of the axis.

Management of the acute odontoid synchondrosis fractures in children is divided into surgical and conservative. Majority of the dontoid synchondrosis fracture heal with external immobilization, but a minority with marked displacement as well as those which are neglected require open reduction and internal fixation.

Herein, 2 boys at the age of 4 years with odontoid synchondrosis fracture are presented. One was admitted shortly after injury and the other after 4 months the acute one was managed with pediatric halo and the neglected one with irreducible atlantoaxial dislocation underwent open atlantoaxial reduction by means of transfacet release and subsequent complete reduction by a new maneuver and instrument, which will be described in detail.