Odontoid fracture: Difference between revisions

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==Background==
==Background==
*Also known as dens fracture
[[File:Odontoid Fractures.jpg|right|thumbnail|The three types of odontoid fracture. Type II and type III are [[Unstable spine fractures|unstable fractures]].]]
*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>
 
*Bimodal distribution
*Fracture of C2 (dens)
**Young - blunt trauma to head, flexion/extension injury
*Bimodal age distribution
**Elderly - fall, with higher morbidity/mortality
**Young - injury secondary to blunt trauma to head or flexion/extension injury
**Elderly - injury secondary to fall, higher morbidity/mortality than young patients
***Increased risk of fracture due to bone loss, which is disproportionate at C2 relative to rest of skeleton
*Frequently associated with other cervical spine injuries
*25% associated with neurologic injury/deficit
*Os odontoideum (normal variant) can look like a Type II odontoid fracture on imaging, causing false postive
 
===Types===
*'''Type I:''' Oblique avulsion fracture of tip of odontoid; alar ligament avulsion
**Stable fracture
*'''Type II:''' Fracture at base of odontoid where it meets C2 body
**Unstable fracture
**High risk of nonunion (30%) due to interruption of blood supply
*'''Type III:''' Extension of the fracture through upper portion of body of C2
**Unstable fracture
 
{{Vertebral fractures and dislocations types}}


==Clinical Features==
==Clinical Features==
*Frequently involves other cervical spine injuries
*Neck pain
*25% associated with neurologic injury
*May have neurologic deficit


==Differential Diagnosis==
==Differential Diagnosis==
{{Cervical spine injuries}}
{{Blunt neck trauma DDX}}


==Diagnosis==
==Evaluation==
*Imaging
*CT is the imaging study of choice
**Xray: AP, lateral, open-mouth odontoid view of cervical spine
*Cervical spine x-ray may be performed if CT unavailable
**CT for further assessment if fracture identified
**Must include open-mouth odontoid view
 
===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==
*Prehospital Immobilization see [[EBQ:Prehospital Spine Immobilization|NAEMSP National Guidelines for Spinal Immobilization]]
*Cervical spine motion restriction via hard cervical collar
*Consult ortho/neurosurgery/trauma
*Consult spine surgery


==Disposition==
==Disposition==
*Admit
*May consider discharge with hard cervical collar for Type I fracture (stable)
**Consider only in consultation with spine surgery service<ref name="Waterbrook">Waterbrook, A. (2016). Sports medicine for the emergency physician: a practical handbook. Cambridge: Cambridge University Press.</ref>


==See Also==
==See Also==
*[[Cervical spine injuries]]
*[[Cervical spine fractures and dislocations]]


==References==
==References==
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[[Category:Trauma]]
[[Category:Trauma]]
[[Category:Ortho]]
[[Category:Orthopedics]]

Latest revision as of 13:17, 24 October 2020

Background

The three types of odontoid fracture. Type II and type III are unstable fractures.
  • Fracture of C2 (dens)
  • Bimodal age distribution
    • Young - injury secondary to blunt trauma to head or flexion/extension injury
    • Elderly - injury secondary to fall, higher morbidity/mortality than young patients
      • Increased risk of fracture due to bone loss, which is disproportionate at C2 relative to rest of skeleton
  • Frequently associated with other cervical spine injuries
  • 25% associated with neurologic injury/deficit
  • Os odontoideum (normal variant) can look like a Type II odontoid fracture on imaging, causing false postive

Types

  • Type I: Oblique avulsion fracture of tip of odontoid; alar ligament avulsion
    • Stable fracture
  • Type II: Fracture at base of odontoid where it meets C2 body
    • Unstable fracture
    • High risk of nonunion (30%) due to interruption of blood supply
  • Type III: Extension of the fracture through upper portion of body of C2
    • Unstable fracture

Vertebral fractures and dislocations types

Vertebral anatomy.
Numbering order of vertebrae.

Clinical Features

  • Neck pain
  • May have neurologic deficit

Differential Diagnosis

Neck Trauma

Evaluation

  • CT is the imaging study of choice
  • Cervical spine x-ray may be performed if CT unavailable
    • Must include open-mouth odontoid view

Management

  • Cervical spine motion restriction via hard cervical collar
  • Consult spine surgery

Disposition

  • Admit
  • May consider discharge with hard cervical collar for Type I fracture (stable)
    • Consider only in consultation with spine surgery service[1]

See Also

References

  1. ↑ Waterbrook, A. (2016). Sports medicine for the emergency physician: a practical handbook. Cambridge: Cambridge University Press.
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