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
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