Odontoid fracture: Difference between revisions
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==Background== | ==Background== | ||
*Also known as dens fracture | *Also known as dens fracture | ||
*Only stable if | *Only stable if fracture confined to avulsion of the tip (superior to transverse ligament)<ref>Clark, J., Abdullah, K. and Mroz, T. (2011) Biomechanics of the Craniovertebral Junction. Edited by Vaclav Klika</ref> | ||
==Clinical Features== | ==Clinical Features== | ||
*Frequently involves other cervical spine injuries | *Frequently involves other cervical spine injuries | ||
*25% | *25% associated with neurologic injury | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Cervical spine injuries}} | {{Cervical spine injuries}} | ||
== | ==Diagnosis== | ||
*Imaging | *Imaging | ||
**Xray: AP, lateral, open-mouth odontoid view of cervical spine | **Xray: AP, lateral, open-mouth odontoid view of cervical spine | ||
**CT for further assessment if fracture identified | **CT for further assessment if fracture identified | ||
===Types=== | |||
*Type I: Oblique avulsion fracture of tip of odontoid; alar ligament avulsion | |||
**Stable | |||
**atlanto-occipital instability should be ruled out with flexion and extension films | |||
*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 | |||
==Management== | ==Management== | ||
Revision as of 12:29, 19 December 2015
Background
- Also known as dens fracture
- Only stable if fracture confined to avulsion of the tip (superior to transverse ligament)[1]
Clinical Features
- Frequently involves other cervical spine injuries
- 25% associated with neurologic injury
Differential Diagnosis
Vertebral fractures and dislocations types
- Cervical fractures and dislocations
- Thoracic and lumbar fractures and dislocations
Diagnosis
- Imaging
- Xray: AP, lateral, open-mouth odontoid view of cervical spine
- CT for further assessment if fracture identified
Types
- Type I: Oblique avulsion fracture of tip of odontoid; alar ligament avulsion
- Stable
- atlanto-occipital instability should be ruled out with flexion and extension films
- 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
Management
- Prehospital Immobilization see NAEMSP National Guidelines for Spinal Immobilization
- Consult ortho/neurosurgery/trauma
Disposition
See Also
References
- ↑ Clark, J., Abdullah, K. and Mroz, T. (2011) Biomechanics of the Craniovertebral Junction. Edited by Vaclav Klika