Segmental fracture of the dens

Abstract

A 76-year-old man suffered a syncopal attack, fell and hit the right parietal region of his head against a doorframe. His only complaint was of mild aching over the posterior aspect of his neck. Examination revealed vague generalised neck tenderness only. He had no neurological symptoms or signs. Cervical spine radiographs suggested a transverse fracture of the base of the odontoid process. There were also degenerative changes at C4/5 with a reversed cervical lordosis. CT scan confirmed an undisplaced vertical fracture through the midline of the anterior arch of the atlas and two fractures of the odontoid process (Figs. 1 and 2). A displaced oblique apical type I fracture and an undisplaced transverse basal type II fracture are shown [1]. Due to general poor health, the patient was treated conservatively in a Philadelphia collar with back and chest extensions [2]. Ten months after injury, a CT scan showed no evidence of fracture union. Persistent mobility was confirmed on controlled flexion-extension views. Despite counselling, the patient refused operative intervention.