![]() Institutional review board approval was obtained. Acute C2 (axis) fractures were identified from International Statistical Classification of Diseases-9 coding from 2008 to 2015. The purpose of this study is to separately evaluate treatment outcomes of complex Type III fractures with external immobilization (halo vest and hard collar orthosis).Ī single-institution, retrospective cohort study was conducted to evaluate the outcome of conservative treatment of complex Type III odontoid fractures. High-energy fractures with comminution of the lateral mass and secondary fracture lines extending into the pars interarticularis or vertebral body have historically been studied together with low-energy simple fractures in the elderly. Current studies recommend nonsurgical management of Type III odontoid fractures with union rates of 85%–100% with external immobilization.Ī considerable amount of heterogeneity exists among Type III fractures. In general, the Type III fracture is believed to have high healing potential due to large fracture surface area through cancellous bone. Type III fractures extend into the vertebral body and account of 39% of all odontoid fractures. Type II fractures occur at the junction of the dens and the C2 vertebral body. Type I fractures occur at the proximal tip of the dens from an avulsion injury. The Anderson and D'Alonzo classification is the most commonly utilized classification system. The great majority of odontoid fractures occur in the elderly population from a low-energy mechanism with a smaller contribution from high-energy accidents in the young. MRI is used for evaluation of ligamentous, disk, spinal cord and soft tissue injuries.The incidence of odontoid fractures varies between age groups and is generally believed to account for approximately 20% of all cervical spine injuries. Furthermore, as odontoid fractures are in the axial plane, CT allows coronal and sagittal reformatting for better depiction. CT is considered a superior modality for fracture visualization and characterization. Successful treatment options include external immobilization with either a hard cervical collar or halo-thoracic vest, or operative management through anterior/posterior fusion techniques.Ĭonventional radiography is frequently firstly used as it is generally readily available, with measurements of fracture displacement and angulation that can be made on lateral cervical views. This fracture type has the best prognosis for healing because of the larger surface area of the fracture. ![]() This fracture is considered mechanically unstable, as it allows the atlas and the occiput to now move together as once unit and independent of the rest of the cervical column. There is a very low incidence of non-union, and surgery is seldom indicated for these fracturesĪ Type III odontoid fracture is characterized by a horizontal fracture through the odontoid with extension into the lateral masses of C2. Management comprises of conservative measures with external immobilization using a hard cervical collar. This is the least common type of odontoid fracture and is generally stable. This fracture is therefore described as an oblique avulsion fracture of the tip of odontoid resulting from avulsion of the alar ligament. This is the point of insertion for the alar ligaments. Management of this fracture type can be non-operative (with a halo-thoracic vest) or operative (posterior atlantoaxial arthrodesis or anterior screw fixation).Ī type I odontoid fracture involves the tip of the dens. These fractures are at higher risk of displacement and angulation (in comparison to the type 1 and 3 subtypes) due to distractive forces from the ligamentous attachment of apical and alar ligaments to the proximal fragment. Important prognostic factors for fracture healing (union versus non-union) are the degree of fracture fragment displacement and angulation. It can be caused by either hyper-flexion or hyperextension mechanisms of injury. This case demonstrates a type 2 odontoid process fracture, a transverse fracture through the base of the dens and represents the most common type of dens fracture.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |