Peer Reviewed

Photoclinic

Odontoid Fracture

Sayed K. Ali, MD, FACP
David K. Watkins
Volume 56 - Issue 11 - November 2016

AUTHORS:
Sayed K. Ali, MD
Orlando Veterans Affairs Medical Center, Orlando, Florida

David K. Watkins
San Antonio Military Medical Center, Fort Sam Houston, Texas

CITATION:
Ali SK, Watkins DK. Odontoid fracture. Consultant. 2016;56(11):1039-1040.

 

An 84-year-old woman with a history significant for hypothyroidism, hypertension, and osteoporosis was at home performing her usual daily chores when her phone suddenly rang. As she advanced to grab it, she slipped on a rug and fell to the floor, sustaining a neck injury. She did not lose consciousness, but since the pain in her neck was intolerable, she called her son to take her to the emergency department (ED).

In the ED, her symptoms and the inability for her to move her neck prompted a computed tomography scan of her cervical spine (Figures 1 and 2). She received a diagnosis of a type III dens fracture.

Discussion. Fractures of the odontoid process are relatively common upper cervical spine injuries, comprising nearly 60% of all fractures of the axis and 5% to 18% of all cervical spine fractures.1-5 These fractures are the most common of all spinal fractures for persons aged 80 years and older and usually result from a low-energy fall.1,2

In 1974, Anderson and D’Alonzo proposed a classification system for odontoid fractures:

Type I. Described to be near the tip of the odontoid process, above the transverse ligament. This type of fracture is rare and accounts for 1% to 5% of odontoid fractures.1,2

Type II. Occurs through the neck of the odontoid. These fractures are the most common (38%-80%) and are considered relatively unstable.1,2

Type III. These fractures extend into the vertebral body and are relatively stable unless severely displaced.1,2

Type I odontoid fractures generally are treated with immobilization with a halo-vest orthosis or hard cervical collar.

Type II fractures are generally less stable and are associated with lower union rates than type I and III fractures. Treatment for type II fractures is less well defined and could include external immobilization or surgical intervention.

Most type III odontoid fractures can be treated with collar immobilization. Some studies have suggested that type III dens fractures with more than 5 mm of vertical distraction are unstable and must be recognized and stabilized operatively.3 

Our patient was evaluated by the neurosurgical team, and after an informed discussion, collar immobilization for 120 days, along with pain management, was recommended.

References:

  1. Gornet ME, Kelly MP. Fractures of the axis: a review of pediatric, adult, and geriatric injuries [published online September 29, 2016]. Curr Rev Musculoskelet Med. doi:10.1007/s12178-016-9368-1.
  2. Sasso RC. C2 dens fractures: treatment options. J Spinal Disord. 2001;14(5):​455-463.
  3. Kirkpatrick JS, Sheils T, Theiss SM. Type-III dens fracture with distraction: an unstable injury: a report of three cases. J Bone Joint Surg Am. 2004;86-A(11):​2514-2518.
  4. Maak TG, Grauer JN. The contemporary treatment of odontoid injuries. Spine (Phila Pa 1976). 2006;31(11 suppl):S53-S60.
  5. Platzer P, Thalhammer G, Oberleitner G, Schuster R, Vécsei V, Gaebler C. Surgical treatment of dens fractures in elderly patients. J Bone Joint Surg Am. 2007;89(8):1716-1722.