80-year-old male patient brought in by ambulance for a witnessed fall. A cervical collar was placed by EMS because of midline neck pain. The patient is neurologically intact. A CT of the cervical spine was obtained and is shown above (Case courtesy of Dr. Talal F M Abdullah, Radiopaedia.org, rID: 58030).
Odontoid fracture, type II. The odontoid process, or dens, is a superior bony projection of C2 that, along with the transverse ligament, is a key stabilizer of C1.
Figure 2. Case courtesy of Dr. Talal F M Abdullah, Radiopaedia.org, rID: 58030. Annotations by author, fracture highlighted in red
Pearl: Odontoid fractures can occur in elderly patients via a low energy mechanism like ground-level falls. They may also occur in younger patients during high-energy trauma that causes hyperflexion or hyperextension.
The patient should be placed in a cervical collar and maintained in strict spinal precautions. A spine surgeon should be consulted emergently as guided by institutional protocols. MRI can be obtained if neurologic symptoms are present.
PEARL: Management typically includes the following
Type I -> hard cervical collar for 6-12wk.
Type II -> operative management (screw fixation or C1-2 posterior fusion) [1-2].
Type III -> hard cervical collar or halo immobilization .
Egol K, Koval, KJ, Zuckerman JD. Handbook of Fractures. Lippincott Williams & Wilkins. 2010 ISBN: 160547760.
Gembruch O, Lemonas E, Ahmadipour Y, Sure U, El Hindy N, Dodel R, Müller O. Treatment of Odontoid Type II Fractures in Octogenarians: Balancing Two Different Treatment Strategies. Neurospine. 2019 Jun;16(2):360-367. Epub 2019 Feb 23. PMID: 31154696.