Type II fractures occur through the base of the odontoid, above the body of C2. This is the most common pattern, accounting for approximately 60-90% of odontoid fractures. This type of injury is also associated with the highest rate of non-union. Patients with this kind of fracture are immobilized in a halo for at least 12 weeks. The rates of non-union with this type of treatment range from 11 to 63% . Risk factors identified which promote non-union, besides the poor vascular supply to the distal odontoid, include age greater than 65 years, displacement of greater than 6 mm and, especially, posterior displacement, severe comminution of the fracture site and delay in diagnosis .
Surgical options currently used include posterior C1-C2 fusion using either atlantoaxial wiring or transarticular C1-C2 screw fixation. An anterior screw fixation by means of tran-sodontoid lag screw placement can also be done if there is documentation of an intact transverse ligament.
In type III fractures, the fracture line passes into the body of C2. Anterior displacement is commonly seen with this type of fracture. Flexion-type forces have been proposed as the mechanism for this type of injury. These injuries have consistently shown a good overall prognosis when treated with halo immobilization for 12 weeks, with non-union rates of 0-15% in patients treated with other cervical orthoses instead of a halo .
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