Odontoid fracture

Background

• Also known as dens fracture
• Only stable if fx confined to avulsion of the tip (superior to transverse ligament)

Clinical Features

• Frequently involves other cervical spine injuries
• 25% assoc w/ neurologic injury

Differential Diagnosis

Vertebral fractures and dislocations types

Vertebral anatomy.

Numbering order of vertebrae.

• Cervical fractures and dislocations
  • Atlanto-occipital dissociation
  • C1
    • Jefferson fracture
    • C1 isolated anterior arch fracture
    • C1 isolated posterior arch fracture
  • C2
    • Odontoid fracture
    • Hangman's fracture
  • C3-C7
    • Cervical burst fracture
    • Cervical spinous process fracture
    • Extension cervical teardrop fracture
    • Flexion cervical teardrop fracture
    • Anterior cervical wedge fracture
  • Cervical facet dislocation
  • Isolated transverse process fracture
• Thoracic and lumbar fractures and dislocations
  • Chance fracture
  • Thoracic burst fracture
  • Lumbar burst fracture
  • Isolated transverse process fracture
  • Thoracic and lumbar compression fractures

Workup

• Types
  • Type I: Oblique avulsion fx of tip of odontoid; alar ligament avulsion
    • Stable
    • atlanto-occipital instability should be ruled out with flexion and extension films
  • Type II: Fx at base of odontoid process where it attaches to C2; Fx 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 fx through upper portion of body of C2
    • Unstable
• Imaging
  • Xray: AP, lateral, open-mouth odontoid view of cervical spine
  • CT for further assessment if fracture identified

Management

• Prehospital Immobilization see NAEMSP National Guidelines for Spinal Immobilization
• Consult ortho/neurosurgery/trauma

See Also

• Cervical spine injuries