Treatment is with anterior odontoid screw if adequate bone density. Lifethreatening fractures can occur as a result of forces acting on this anatomical structure due to its proximity to the spinal cord and brainstem. In a retrospective analysis of 23 geriatric 70 years patients with a fracture of the odontoid, we compared some of the clinical features to a contemporary series of patients younger than 70 years of age. Treatment modality in type ii odontoid fractures defines the. Use of videoassisted intubation devices in the management of patients with trauma. To investigate bone status in elderly patients sustaining a low energy odontoid fracture.
The full text of this article is available in pdf format. Odontoid fracture type ii is found to have high incidence of nonunion after the conservative management, especially in elderly patients over 50 years 5. What is the role of an odontoid view in the radiologic workup. The sensitivity of stir to detect fracture in the age group 57 years and older was significantly worse than that in the age group younger than 57 years 54% and 82%, respectively.
The surgical treatment of type ii odontoid fractures showed satisfactory results in relation to time to consolidation of the fracture and low incidence. The management of odontoid fractures remains controversial. Jan 08, 2018 presented by michele johnson, md, of the university of texas houston. Odontoid process fracture an overview sciencedirect topics. The management of patients with odontoid fractures is initiated in the field with neck immobilization and stabilization. It can be the only radiological sign of a type iii low odontoid fracture in an elderly patient. Presented by michele johnson, md, of the university of texas houston. The management of these fractures is controversial. A fracture of the odontoid bone also called the dens, is an upward extension of c2 cervical vertebrae i. There is controversy regarding whether operative or nonoperative management is the best treatment for elderly patients with type ii odontoid fractures. Odontoid fractures account for approximately 20% of all fractures of the cervical spine. Treatment depends on the location of the fracture within the c2 vertebrae defined by the anderson and dalonzo classification system and the patients risk factors for nonunion failed bone healing.
In a retrospective analysis of 23 geriatric 70 years patients with a fracture of the odontoid. Despite their frequency, there is considerable ambiguity regarding optimal management strategies for these fractures in the elderly. Treatment modality in type ii odontoid fractures defines. Surgical strategies for treating odontoid fracture type ii include direct anterior odontoid screw fixation aosf and posterior cervical. Fracture of the odontoid superior to its attachment to the body of c2 is known as a type i fracture.
Sep 12, 2010 considerable controversy exists regarding the optimal management of elderly patients with type ii odontoid fractures. Odontoid fractures constitute 920% of all adult cervical spine fractures. Complications related to the management of odontoid fractures paul kraemer rick c. The management of acute odontoid fractures still remains controversial. Odontoid fractures are the most common fracture of the axis and the most common cervical spine fracture in patients over 65. General description odontoid projects superiorly from body of axis c2 odontoid attaches to articular facet on anterior arch of atlas odontoid allows enormous mobility rotation for the atlas and occiput ligaments.
The treatment of specific c1c2 fracture combinations has been the subject of numerous reports. Type iii odontoid fractures management in the elderly consisted of 18 manuscripts all graded as very low quality evidence literature. Orthopedics a fracture of the odontoid process is the most common injury to the second cervical vertebrae. This is a very important case of providing spine surgeons with a treatment plan for treating patients with old type ii odontoid fractures complicated. Type ii fractures, which occur at the base of the dens, are by far the most common odontoid fractures seen in clinical practice. The objective of the study was to evaluate the published. There are many influencing factors leading to appropriate treatment of odontoid fractures such as age, bone quality, arthrosis, classification, and. Odontoid fractures are the most common cervical spine fracture in the elderly, and their incidence is increasing. Historically, there has been some debate in the literature with regards to optimal management strategies to maximize outcomes in geriatric patients. Because of the previously reported high incidence of nonunion and delayed complications, a variety of effective methods for stabilization have been devised 2 4, 12, , 19, 24, 26, 27, 29 35, 41 48, 51. It constitutes 10%15% of all cervical spine fractures. Orthopedics a fracture caused by sudden forward and backward movement of the head with respect to the trunk, with a shearing of the dens from the body of c2, with forward movement by the transverse ligament, with backward movement by the anterior arch of c1.
Odontoid fractures comprise 915% of all cervical spine fractures. The best treatment remains unclear because of the morbidity associated with prolonged cervical immobilisation versus the risks of surgical intervention. Pdf the management of odontoid fractures remains controversial. Dens fractures comprise the majority of all cervical fractures in patients older than 80 years and remain the most common cervical fracture pattern in all geriatric patients. The commonest type of the axis injury is an odontoid fracture at. The odontoid process, also called the dens, is a protuberance of the axis. Patients with an odontoid fracture, admitted for surgical stabilization, between january 2008 and march 2014, were included in the study. Request pdf management of type ii odontoid fractures in the geriatric population retrospective study. Odontoid fractures and their management topics in spinal. Surgical versus conservative management for an odontoid. Complications related to the management of odontoid fractures. Incidence of dysphagia after odontoid screw fixation of. Reliability of the stir sequence for acute type ii. Nonoperative treatment of displaced type ii odontoid peg.
This is the least common type of odontoid fracture and is generally stable. Surgical management of odontoid fractures at level one. Seventyfive patients with type ii odontoid fracture and 75 healthy controls mean and median age of 57 years were identified. Twenty three patients with c1 type ii odontoid fractures were treated according to our management. They represent the most common cervical spine injury for patients older than 70 years, the majority being type ii fractures 6574%, which are considered to be relatively unstable.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. Odontoid fracture definition of odontoid fracture by. Approximately 50% of axial rotation of the cervical spine occurs at the c1c2 articulation. Instability at this level occurs most commonly as a result of fractures of the odontoid or bursting injuries of the atlas with disruption of the transverse ligament. N2 recognition of the incidence of odontoid fractures as well as the associated morbidity and unexpectedly high mortality rates has prompted significant changes in the management of these fractures in the past decade. Similar to the literature on isolated type ii odontoid fracture. Odontoid process fractures are the most common fracture of the 2nd cervical vertebrae pratt et al. Odontoid fractures to fuse or not to fuse orthopaedicsone. The main objective of this study was to identify association between fracture union and functional outcome among patients with type 2 odontoid fractures who were been. Nonoperative management of types ii and iii odontoid.
For stable type iii odontoid fracture without significant\. The desire to maintain cervical motion following an odontoid fracture is attractive, and, thus, odontoid screw fixation has been increasingly reported. During appropriate trauma management according to advanced trauma life support guidelines, radiographic evaluation of the cervical spine is obtained. Possible treatment options are either conservative or surgical.
The majority of these fractures are type ii and are associated with significant morbidity in the elderly population, irrespective of treatment options surgical vs. Pdf management of odontoid fractures in the elderly. Management of odontoid fractures in the elderly practiceupdate. Management of odontoid fractures in the elderly article pdf available in european spine journal 85. The odontoid fracture was displaced in 2 of the 8 pa tients. Off all the cases of cervical trauma, about one out of five involves the axis1. Conservative treatment in patients with type 2 odontoid. Optimal treatment for odontoid fractures in the elderly. Management of acute combination fractures of the atlas and axis. To evaluate the therapeutic effects of combined atlas fracture with type ii c1 type ii odontoid fractures and to outline a management strategy for it. Odontoid fractures are relatively common fractures of the c2 vertebral body axis that can be seen in low energy falls in eldery patients and high energy traumatic injuries in younger patients. In odontoid fractures, surgical stability can be achieved by either fracture fixation of the c2 body to the odontoid process or by arthrodesis of the c1c2 motion segment.
Management of odontoid fractures in the elderly springerlink. There is uncertainty regarding the consequences of nonunion. Reliability of the stir sequence for acute type ii odontoid. Odontoid fractures are the most common spinal fracture in the elderly, with rising incidence and costs. Orthopedics although a consensus exists on the nonoperative management of types i and iii odontoid peg fractures, treatment of type ii fractures remains controversial. These structures may be difficult to visualize effectively. Odontoid fractures comprise 920% of all cervical spine fractures. Metastatic odontoid fracture management by anterior screw fixation. Sasso care of the patient with an odontoid fracture continues to be fraught with difficulty. Management of combined atlas fracture with type ii. Contemporary management of adult cervical odontoid fractures. The desire to maintain cervical motion following an odontoid fracture is attractive, and, thus, odontoid.
Current who definition of osteoporosis excludes cervical fractures. Lifethreatening fractures can occur as a result of forces acting on this anatomical structure. There is a lack of consensus on optimal management strategies. Type ii occurs at the base of the odontoid process and represents the most common fracture type. Evaluation and acute management of cervical spinal column injuries in adults view in chinese scenarios, including trauma involving elder patients, who are more likely to sustain type ii odontoid fractures. What is the role of an odontoid view in the radiologic. Oct 01, 2000 orthopedics a fracture of the odontoid process is the most common injury to the second cervical vertebrae. Displaced fracture with fracture line from anterosuperior to posteroinferior. Case report type ii old odontoid fractures in the ankylosing. Complications may arise during diagnosis, nonoperative management, decisionmaking regarding operative management technique, or by execution of the chosen surgical method. Controversies in the management of geriatric odontoid. Management of type ii odontoid fractures in the geriatric. Odontoid fractures are frequent in patients over 70 years of age, and in patients over 80 years of age they form the majority of spinal fractures. However, in atraumatic odontoid fractures, mainly reported by orthopedic surgeons, bone status has not been described yet 1.
The aospine north america geriatric odontoid fracture mortality. We conducted a prospective study from january 2016 to january 2017 in patients. Pdf evidencebased analysis of odontoid fracture management. Fracture along the attachment of the odontoid process to the body of c2 is known as a type ii fracture, and fracture of the. Current concepts in the management of type ii odontoid fractures. Considerable controversy exists regarding the optimal management of elderly patients with type ii odontoid fractures. In a retrospective analysis of 23 geriatric 70 years patients with a fracture of the odontoid, we compared some of the clinical features to a. Objective to establish recommendations for the treatment of odontoid fractures based on current.
The fracture healed in 4 patients and progressed to nonunion in 2 patients. In centre two, odontoid fracture line was fixed by anterior screws. Evaluation and treatment of odontoid and hangmans fractures. Tracheal tube placement in patients with type iii odontoid fractures should be performed very carefully to prevent. Of the 35 elderly type ii odontoid fracture manuscripts only 4 were graded as low quality evidence and the remaining articles were graded as very low quality of evidence. Management comprises of conservative measures with external immobilization using a. Fracture from anteroinferior to posterosuperior, or with significant comminution. This fracture is therefore described as an oblique avulsion fracture of the tip of odontoid resulting from avulsion of the alar ligament.
Evidencebased analysis of odontoid fracture management in. In one centre, the treatment was pos terior c1c2 stabilization with screws and plate. Surgical versus conservative management for an odontoid fracture a serious neck injury the seven bones making up the neck region of the backbone are called the cervical vertebrae. The first vertebra, called the atlas, supports the skull. Surgical management of odontoid fractures at level one trauma. The present study was carried out to focus on the nuances involved in the surgical management of odontoid fractures. Although surgery may reduce mortality rates from type ii odontoid fractures in the elderly population, postoperative dysphagia resulting from screw fixation remains a serious complication. However, good radiological outcome union does not necessarily provide good functional outcome. Type ii odontoid fractures have been associated with limited healing potential, and both nonoperative and operative management are associated with high mortality rates. The mechanism of injury is variable, and can occur both during flexion or extension with or without compression 5 classification. Odontoid process fracture, also known as the peg or dens fracture, occurs where there is a fracture through the odontoid process of c2 pathology. The mechanism of injury is variable, and can occur both during flexion or extension with or without compression 5. Fracture of the odontoid process is the most common type of cervical spine fracture in elderly patients i. Four of the 8 pa tients with neurologic deficits had initial weakness of one or both extremities on one side.
336 72 664 183 469 1251 1228 1029 1201 279 427 863 904 667 1287 529 360 1406 953 735 1398 874 1385 1489 1155 436 903 568 1143 38 208 187 488 733 472 490 27 549 1455