Odontoid fracture: Difference between revisions
(→Types) |
No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
[[File:Odontoid Fractures.jpg|right|thumbnail|The three types of odontoid fracture. Type II and type III are [[Unstable spine fractures|unstable fractures]].]] | |||
*Fracture of C2 (dens) | |||
*Frequently | *Bimodal age distribution | ||
*25% associated with neurologic injury | **Young - injury secondary to blunt trauma to head or flexion/extension injury | ||
**Elderly - injury secondary to fall, higher morbidity/mortality than young patients | |||
*Frequently associated with other cervical spine injuries | |||
*25% associated with neurologic injury/deficit | |||
*Os odontoideum (normal variant) can look like a Type II odontoid fracture on imaging, causing false postive. | |||
* | |||
===Types=== | ===Types=== | ||
| Line 33: | Line 22: | ||
*Type III: Extension of the fracture through upper portion of body of C2 | *Type III: Extension of the fracture through upper portion of body of C2 | ||
**Unstable | **Unstable | ||
==Clinical Features== | |||
*Neck pain | |||
*May have neurologic deficit | |||
==Differential Diagnosis== | |||
{{Cervical spine injuries}} | |||
==Evaluation== | |||
*CT is the imaging study of choice | |||
*Cervical spine x-ray may be performed if CT unavailable | |||
**Must include open-mouth odontoid view | |||
==Management== | ==Management== | ||
* | *Cervical spine motion restriction via hard cervical collar | ||
*Consult spine surgery | |||
*Consult | |||
==Disposition== | ==Disposition== | ||
*Admit | |||
*May consider discharge with hard cervical collar for Type I fracture (stable). Must be done in consultation with spine surgery.<ref name="Waterbrook">Waterbrook, A. (2016). Sports medicine for the emergency physician: a practical handbook. Cambridge: Cambridge University Press.</ref> | |||
==See Also== | ==See Also== | ||
Revision as of 09:22, 8 September 2017
Background
The three types of odontoid fracture. Type II and type III are unstable fractures.
- Fracture of C2 (dens)
- Bimodal age distribution
- Young - injury secondary to blunt trauma to head or flexion/extension injury
- Elderly - injury secondary to fall, higher morbidity/mortality than young patients
- Frequently associated with other cervical spine injuries
- 25% associated with neurologic injury/deficit
- Os odontoideum (normal variant) can look like a Type II odontoid fracture on imaging, causing false postive.
Types
- Type I: Oblique avulsion fracture of tip of odontoid; alar ligament avulsion
- Stable
- Atlanto-occipital instability (AAI) should be ruled out with flexion and extension films
- AAI requires surgical management
- Type II: Fracture at base of odontoid process where it attaches to C2; Fracture through waist
- Unstable
- High nonunion rate due to interruption of blood supply
- Young: Halo if no risk factors for nonunion, Surgery if risk factors for nonunion
- Elderly: Collar if not surgical candidates, Surgery if surgical candidates
- Type III: Extension of the fracture through upper portion of body of C2
- Unstable
Clinical Features
- Neck pain
- May have neurologic deficit
Differential Diagnosis
Vertebral fractures and dislocations types
- Cervical fractures and dislocations
- Thoracic and lumbar fractures and dislocations
Evaluation
- CT is the imaging study of choice
- Cervical spine x-ray may be performed if CT unavailable
- Must include open-mouth odontoid view
Management
- Cervical spine motion restriction via hard cervical collar
- Consult spine surgery
Disposition
- Admit
- May consider discharge with hard cervical collar for Type I fracture (stable). Must be done in consultation with spine surgery.[1]
See Also
References
- ↑ Waterbrook, A. (2016). Sports medicine for the emergency physician: a practical handbook. Cambridge: Cambridge University Press.