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Odontoid Fracture

 Spinal Cord Anatomy

Glasgow Coma Scale

Upper Extremity Sensory innvervation

synonyms:

Odontoid Fracture ICD-10

 

Odontoid Fracture Etiology / Epidemiology / Natural History

  • Mechanism of injury not clearly defined. Generally caused by head impact.
  • High energy trauma in young patients, low0energy in elderly patients.

Odontoid Fracture Anatomy

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Odontoid Fracture Clinical Evaluation

  • Palpate entire spine for tenderness / step off.
  • Complete neuro exam: motor strength, pin-prick sensation, reflexes, cranial nerves, rectal examination (perineal pin-prick sensation, sphincter tone, volitional spincter control)
  • Absence of the bulbocaverosus reflex indicates spinal shock. Level of spinal injury can not be determined until bulbocaverosus reflex has returned..

Odontoid Fracture Xray / Diagnositc Tests

  • A/P, Lateral, Odontoid. Best seen on odontoid view.
  • CT scan generally indicated to further define fracture.

Odontoid Fracture Classification / Treatment

  • Type I: rare; avulsion of the tip of the odontoid at the site of attachment of the alar ligament. Must rule out Occipitocervical Dissociation . If isolated injury is stable.
    -Treatment = hard collar.
  • Type II: fracture through the base at or just below the level of the superior articular processes.
    -Treatment = posterior C1-2 wire fixation and fusion or anterior odontoid screw fixation. Up to 50% nonunion with non-op treatment. Consider orthosis alone for elderly low-demand patients.
  • Type III: fracture of the body of the axis.
    -Treatment = reduction and halo vest.

Odontoid Fracture Associated Injuries / Differential Diagnosis

Odontoid Fracture Complications

Odontoid Fracture Follow-up Care

Odontoid Fracture Review References

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