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Odontoid Fracture
From WikiSM
Contents
Other Names
- Odontoid Process Fracture
- C2 Fracture
- Dens Fracture
- Axis Fracture
Background
- This page refers to fractures of the Odontoid Process of C2
Epidemiology
- Account for 9-15% of adult cervical spine fractures[1]
- Most common fracture of Axis (need citation)
- Bimodal distribution: young males, elderly females (need citation)
Pathophysiology
- Typically associated with high energy trauma
- Displacement can be due to hyperflexion (anterior) or hyperextension (posterior)
- Anterior: due to failure of transverse ligament and/or atlanto-axial instability
- Posterior: direct impact from anterior arch during extension
Pathoanatomy
- C2 (Axis)
- Composed of odontoid process and body
- Articulates with C1 and C3
- Stabilized by transverse, apical and alar ligaments
Associated Injuries
- Up to 34% of odontoid fractures have additional cervical spine injuries[2]
- Subaxial fracture
- Atlanto Occipital Dissociation
- Transverse Ligament Rupture
- Posterior Interspinous Ligament Disruption
- Atlantoaxial Instability
- Os Odontoideum
- Looks like a Type II odontoid fracture
- Etiology: failure of fusion during childhood or old traumatic process
Risk Factors
- Unknown
Differential Diagnosis
- Fractures
- Subluxations and Dislocations
- Neuropathic
- Muscle and Tendon
- Pediatric/ Congenital
- Other Etiologies
Clinical Features
- General: Physical Exam Neck
- History
- History of trauma
- Complains of neck pain, worse with movement
- Can have dysphagia due to retropharyngeal hematoma
- Physical Exam
- Uncommon to have neuro deficits
- Special Tests
Evaluation
Radiographs
- Standard 3 view C spine films can be helpful
- Open-mouth (odontoid view) can be diagnostic
- Flexion-extension views to evaluate for occiptocervical stability
CT
- Gold standard for evaluating C-spine in the setting of trauma
- Allows for better characterization of fracture patterns, displacement
- Consider angiography
MRI
- Indicated if any neurological deficits
- Better evaluate soft tissues
Classification
Anderson and D'Alonzo Classification
- Type I: Fracture is at the tip[3]
- Type II: Base of dens
- Type III: Body of C2
Grauer Classification of Type II Odontoid fractures
- Type IIA: Nondisplaced/minimally displaced with no comminution
- Type IIB: Displaced fracture with fracture line from anterosuperior to posteroinferior
- Type IIC: Fracture from anteroinferior to posterosuperior, or with significant comminution.
Management
Prognosis
- Associated with a high rate of morbidity and mortality
- Increases significantly in elderly patients
- Type I: Excellent prognosis if uncomplicated[4]
Nonoperative
- Os Odontoideum
- Observation
- Type I
- Generally non surgical management
- Indications: Stable, no co-occurring injuries
- Technique: Immobilize in rigid cervical collar
- Type II
- Type III
- Indications: Stable/ non displaced
- Technique: halo vest or a nonrigid orthosis (cervical collar)
Operative
- Type II
- Risk factors: age > 40, significant displacement (>5 mm), angulation (>11°), neuro deficits, comminution
- Indications: risk factors above or failure of conservative management, although some surgeons recommend surgical management for call cases
- Technique: atlantoaxial arthrodesis, occipitocervical fusion with C1 laminectomy
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play
- Needs to be updated
Complications
- Nonunion
- Orthosis complications
- Pin site loosening
- Infection
- Pressure sores
- Limitation of respiratory function
- Difficulty swallowing
- Surgical
- Respiratory complications
- Loss of function, mobility, range of motion
See Also
- Internal
- External
- Sports Medicine Review Neck Pain: https://www.sportsmedreview.com/by-joint/neck/
References
- ↑ Vaccaro AR, Madigan L, Ehrler DM: Contemporary management of adult cervical odontoid fractures. Orthopedics 2000;23(10):1109-1115
- ↑ Green RA, Saifuddin A: Whole spine MRI in the assessment of acute vertebral body trauma. Skeletal Radiol 2004; 33(3):129-135
- ↑ Anderson LD, D'Alonzo RT: Fractures of the odontoid process of the axis. J Bone Joint Surg Am 1974;56(8):1663-1674
- ↑ 4.0 4.1 Julien TD, Frankel B, Traynelis VC, Ryken TC: Evidence-based analysis of odontoid fracture management. Neurosurg Focus 2000;8(6):e
- ↑ Müller EJ, Schwinnen I, Fischer K, Wick M, Muhr G: Non-rigid immobilisation of odontoid fractures. Eur Spine J 2003; 12(5):522-525
- ↑ Koivikko MP, Kiuru MJ, Koskinen SK, Myllynen P, Santavirta S, Kivisaari L: Factors associated with nonunion in conservatively-treated type-II fractures of the odontoid process. J Bone Joint Surg Br 2004;86(8):1146-1151
- ↑ Hsu, Wellington K., and Paul A. Anderson. "Odontoid fractures: update on management." JAAOS-Journal of the American Academy of Orthopaedic Surgeons 18.7 (2010): 383-394.