The positive outcome of conservative treatment in terms of higher union rate is related to the higher stability of the Type I and III fractures in comparison to Type II fractures. The treatment of Type I and Type III odontoid fractures has shown to be effective on a conservative manner. Conservatively, the two most reported treatment options are the Halo vest and the rigid cervical collar. Surgically, the two discussed treatments are anterior screw fixation and posterior C1-C2 fusion. In the literature, mainly 4 treatment strategies are reported, each with distinct pros and contras.
ODONTOID FRACTURE FULL
Beside the assessment of the co-morbidities it is very important to subject the patient to a full neurological examination. It is very important to asses any co-morbidities in the diagnostic process because they can affect the treatment.
A type 2C is a fracture that extends from antero-inferior to postero-superior and is treated with instrumental fusion of C1 – C2. A type 2B is displaced and is generally treated with anterior screw fixation. A type 2A fracture is minimally displaced and is treated with external immobilisation. There is a subdivision of type 2 fractures.
Type III: fracture extends into the body of the axis. Type II: fracture through the base of the dens, at the junction of the odontoid base and the body of C2. Type I: avulsion fracture of the apex. Type I fractures occur very rarely and type II is the most common This is called the Anderson and D’Alonzo classification. There are three different types of odontoid process fracture characterised by the anatomic location of the fracture line. Other possible mechanisms include blunt trauma or hyperflexion trauma. The underlying mechanism of injury is hyperextension of the neck. a motor vehicle accident) and in elderly patients due to a low-energy trauma (e.g. The demographic group varies as these fractures occur in both in young patients due to a high-energy trauma (e.g. Įpidemiology /Etiology įractures of the dens represent almost 15% of all cervical spine injuries and represent the most common axial fracture type. Structures that cannot be forgotten are the cervical nerves who pass above and underneath the axis these nerves are crucial for both the head as the respiratory system (diaphragm). If any displacement of this form would occur the spinal cord can be compromised due to the narrowing of the vertebral foramen. This ligament prevents anterior displacement of C1 and posterior displacement of C2. The odontoid process and anterior arch of the atlas are held together by the transverse ligament of the atlas. The craniovertebral joints distinguish themselves of the others vertebral joints because they do not have intervertebral discs therefore they possess a wider range of motion than the rest of the vertebral column. The craniovertebral joint between the atlas and the axis is called, the atlanto-axial joint. The C1 vertebra, carrying the cranium, rotates on this. The odontoid process lies anterior to the spinal cord and is used as the pivot for the rotation of the head. The axis shows a peg-like odontoid process that projects itself superiorly from the body. The C2 vertebra, also known as the axis, is one of three atypical vertebrae.
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