Odontoid fracture: Difference between revisions

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]

References

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

Authors:

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

[1]

@@ Line 1: / Line 1: @@
 ==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 fx confined to avulsion of the tip (superior to transverse ligament)
+*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}}
 ==Clinical Features==
-*Frequently involves other cervical spine injuries
+*Neck pain
-*25% assoc w/ neurologic injury
+*May have neurologic deficit
 ==Differential Diagnosis==
-{{Cervical spine injuries}}
+{{Blunt neck trauma DDX}}
-==Workup==
+==Evaluation==
-*Types
+*CT is the imaging study of choice
-**Type I: Oblique avulsion fx of tip of odontoid; alar ligament avulsion
+*Cervical spine x-ray may be performed if CT unavailable
-***Stable
+**Must include open-mouth odontoid view
-***atlanto-occipital instability should be ruled out with flexion and extension films
-**Type II: Fx at base of odontoid process where it attaches to C2; Fx 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 fx through upper portion of body of C2
-***Unstable
-*Imaging
-**Xray: AP, lateral, open-mouth odontoid view of cervical spine
-**CT for further assessment if fracture identified
 ==Management==
-*Prehospital Immobilization see [[EBQ:Prehospital Spine Immobilization|NAEMSP National Guidelines for Spinal Immobilization]]
+*Cervical spine motion restriction via hard cervical collar
-*consult ortho/nsg/trauma
+*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<ref name="Waterbrook">Waterbrook, A. (2016). Sports medicine for the emergency physician: a practical handbook. Cambridge: Cambridge University Press.</ref>
 ==See Also==
-*[[Cervical spine injuries]]
+*[[Cervical spine fractures and dislocations]]
+==References==
+<references/>
 [[Category:Trauma]]
-[[Category:Ortho]]
+[[Category:Orthopedics]]