![]() In the geriatric population, trauma can happen after lower energy consequences for example falls from a standing position. In more youthful patients, they are generally the result of high-impact trauma, which happens as a consequence of a motor cycler or diving accident. Odontoid fractures happen as a consequence of trauma to the cervical spine. The cervical nerves that flow above and below the axis are important for both the head and the respiratory system (diaphragm), thus they must not be overlooked as structures. If any displacement of this form occurs, the spinal cord can be compromised due to the narrowing of the vertebral foramen. This ligament avoids the volar displacement of C1 and the dorsal displacement of C2. The odontoid process and anterior arch of the atlas are maintained together by the transverse ligament of the atlas. Because they lack intervertebral discs, the craniovertebral joints set themselves apart from other vertebral joints by having a wider range of motion than as compared to the vertebral column. The craniovertebral joint between the atlas and the axis is known as, the atlanto-axial joint. The C1 vertebra, which maintains the cranium, rotates on this. The odontoid approach lies anterior to the spinal cord and is utilized as the pivot for the rotation of the head. The axis denotes an odontoid process that extends superiorly from the body and resembles a peg. The C2 vertebra, also called the axis, is one of three atypical vertebrae. The fracture of the odontoid process is classified into one of three types: type I, type II, or type III fractures, depending on the size and morphology of the fracture. Dynamic radiographic imaging is advised if instability caused by the avulsion of the alar ligament is suspected. Type I: consists of the tops of the dens and is mostly stable. The largest single component of the cervical spine’s lateral rotation is provided by the first cervical vertebra (atlas), which rotates around the odontoid process. Due to this anatomical structure’s closeness to the spinal cord and brainstem, pressures operating on it may induce life-threatening fractures.Ī bone fragment that extends superiorly from the second cervical vertebra (C2, or the axis), is known as the odontoid process or dens. The odontoid process, or dens, is a bony projection from the second cervical vertebra (C2), which allows for rotational movement of the head.Ī protuberance of the axis is the odontoid process, sometimes referred to as the dens. Surgical Treatment of odontoid fractureĪn odontoid fracture, also known as a dens fracture or a type II odontoid fracture, is a specific type of fracture that occurs at the base of the skull in the upper cervical spine.It is important to keep a high level of suspicion for this unusual subtype of Type III odontoid fracture. ![]() Traction was not applied.Īs soon as the patient was systemically stable, she was taken to the operating room for C1-C2 fixation with a screw-rod construct supplemented by cable and structural iliac crest bone graft.ĭelayed recognition of this subtype of Type III odontoid fracture could have fatal or highly morbid consequences, such as quadriparesis/-plegia, lower brainstem dysfunction, and ventilator-dependence, for the patient. The patient was kept in a rigid collar, placed in a kinematic bed, and admitted to the trauma service for the management of her life-threatening systemic injuries. We present the case of a 73-year-old woman with a vertically distracted Type III odontoid fracture and associated quadriparesis and brainstem deficits. Not recognizing or not treating this injury urgently and aggressively could lead to devastating iatrogenic neurological injuries such as quadriplegia and fatal lower brainstem palsies. However, there is a rare subtype of Type III odontoid fractures that is similar in the degree of instability to atlanto-occipital dislocation injuries. Type III odontoid fractures are generally thought of as unstable fractures that can be successfully treated with an external orthosis.
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