Abstract
Odontoid fractures account for approximately 7-15% (1) of cervical spine fractures, and almost 60% of fractures involving the axis. Neurological involvement is seen in upto 25% pts (2), and the primary mortality rate is around 12% (2). The mean age of occurrence is 47 years, with 2 peaks. In younger individuals, the fracture usually occurs due to a high velocity injury. In the elderly, hyperextension of the head and neck during domestic falls is the most common mode of injury. These injuries are frequently missed in the elderly, and the mortality is higher as compared to younger patients.
Highlights
Type I & type III fractures are successfully treated non-operatively, untreated type II fractures of the dens are known to have a 60% rate of non-union [1].2
Anterior screw fixation of the odontoid is recommended for Type II and shallow type III fractures in patients who have either failed conservative treatment, or are unable to tolerate halo- vests
Fracture healing has been reported in upto 85% of undisplaced or minimally displaced Type II fractures in young patients, who can tolerate halo- vest immobilization
Summary
The detailed anatomy of the craniovertebral junction (CVJ) has already been dealt with earlier in this monogram (chapter 2). The mean antero-posterior external diameter is around 10.5mm This implies that the permissible critical diameter for passage of screws into the odontoid, traversing the fractured segments is approximately 9 mm. The causes of non-union are thought to be: 1) The alar and apical ligaments attached to the apex of the odontoid hold the fractured dens away from the C2 body. Failure of the transverse ligament allows anterior subluxation of C1 on C2 It extends between the tubercles on the medial side of the lateral mass of atlas, and passes behind the odontoid process in a shallow groove. It is concave in front and convex behind, and, broader and thicker in the middle. Type 2 injuries involve an isolated avulsion of the medial tubercle of the C1 lateral mass, or an avulsion with a fracture of the lateral mass (Figure 2b)
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