Odontoid Fracture

synonyms:

Odontoid Fracture ICD-9

Odontoid Fracture Etiology / Epidemiology / Natural History

• Mechanism of injury not clearly defined. Generally caused by head impact.
• High energy trauma in young patients, low0energy in elderly patients.

Odontoid Fracture Anatomy

• See Spine anatomy.

Odontoid Fracture Clinical Evaluation

• Palpate entire spine for tenderness / step off.
• Complete neuro exam: motor strength, pin-prick sensation, reflexes, cranial nerves, rectal examination (perineal pin-prick sensation, sphincter tone, volitional spincter control)
• Absence of the bulbocaverosus reflex indicates spinal shock. Level of spinal injury can not be determined until bulbocaverosus reflex has returned.
• See ASIA form.

Odontoid Fracture Xray / Diagnositc Tests

• A/P, Lateral, Odontoid. Best seen on odontoid view.
• CT scan generally indicated to further define fracture.

Odontoid Fracture Classification / Treatment

• Type I: rare; avulsion of the tip of the odontoid at the site of attachment of the alar ligament. Must rule out Occipitocervical Dissociation . If isolated injury is stable.
  -Treatment = hard collar.
• Type II: fracture through the base at or just below the level of the superior articular processes.
  -Treatment = posterior C1-2 wire fixation and fusion or anterior odontoid screw fixation. Up to 50% nonunion with non-op treatment. Consider orthosis alone for elderly low-demand patients.
• Type III: fracture of the body of the axis.
  -Treatment = reduction and halo vest.

Odontoid Fracture Associated Injuries / Differential Diagnosis

Odontoid Fracture Complications

Odontoid Fracture Follow-up Care

Odontoid Fracture Review References

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