Odontoid Fractures

These account for 7-14% of all cervical spine fractures and 18% of odontoid fractures present with other cervical spine injuries. They are usually the result of motor vehicle accidents in young adults. The mechanism of injury in elderly patients is usually falls at home. It is not uncommon for the diagnosis to be delayed because of altered mental status. In younger patients, scalp lacerations, facial trauma or history of concussion should alert the clinician to the possibility of an odontoid fracture. Patients rarely present with neurological deficits, but usually complain of occipital or high cervical pain. Numbness and paresthesia in the distribution of the greater occipital nerve and posterior cervical muscle spasms should lead to further investigation. Lateral plain radiographs may miss these fractures, so careful evaluation of the open-mouth view is critical. The pre-vertebral soft tissues should be examined, although pre-vertebral swelling may not be a common finding in isolated odontoid fractures. The pre-dens space or atlanto-dens interval (ADI) should be less than 3 mm in the adult and less than 4 mm in the child. In the case of CT scanning, the fracture line may be missed on the axial cuts because of its being in the plane of the image. Sagittal and coronal reconstructions are then necessary for further evaluation. Odontoid fractures are commonly classified according to the scheme of Anderson and D'Alonzo (Fig. 22.4) [18].

Type I fractures are characterized by an avulsion of the distal tip of the odontoid. The mechanism of injury is thought to be severe rotational and lateral bending forces, which cause avulsion of bone through the alar and apical ligaments. These are usually uncommon injuries and are not associated with instability. Once an associated distraction injury is ruled out, these patients can be treated safely in a cervical collar. Even when union does not occur, patients are usually asymptomatic and the clinical results are satisfactory.

Fig. 22.4. a Odontoid fractures are commonly classified according to the scheme of Anderson and D'Alonzo. Type I fractures are characterized by an avulsion of the distal tip of the odontoid. Type II fractures occur through the base of the odontoid, above the body of C2. Type III fractures involve the fracture line passing into the body of C2. b The lateral mass fracture of C2, usually produced by an axial loading force, similar to the one producing fractures of C1.

Fig. 22.4. a Odontoid fractures are commonly classified according to the scheme of Anderson and D'Alonzo. Type I fractures are characterized by an avulsion of the distal tip of the odontoid. Type II fractures occur through the base of the odontoid, above the body of C2. Type III fractures involve the fracture line passing into the body of C2. b The lateral mass fracture of C2, usually produced by an axial loading force, similar to the one producing fractures of C1.

Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

Get My Free Ebook


Post a comment