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A fracture of the dens (otherwise known as the odontoid), which is the proximal
process arising from C2 (the axis). Based on their location as well as patient
characteristics, these can be treated non-operatively or surgically.
History
Physical Exam
Diagnosis
Imaging
Classification
Treatment Plan
Non-operative
• High morbidity/mortality of halo vests, especially in patients >70 years old (2×
mortality than c-collar)
– Aspiration, cardiac arrest, pin site infection, pin loosening
• Closed reduction with axial traction
– If posterior displacement, cord impingement and neurologic symptoms
– Secure airway prior to reduction to prevent respiratory compromise
– Stabilize neck during intubation to avoid fracture displacement
– Beware of over-distraction! *IMPORTANT*
Surgical
References
Grauer JN, Shafi B, Hilibrand AS, Harrop JS, Kwon BK, Beiner JM, et al. Proposal of a modified,
treatment-oriented classification of odontoid fractures. Spine J. 2005;5(2):123–9.
Hsu WK, Anderson PA. Odontoid fractures: update on management. J Am Acad Orthop Surg.
2010;18:383–94.