Odontoid fracture type 17/2/2023 ![]() Spine 14:1065–1070Īlthoff B (1979) Fracture of the odontoid process. Non-rigid immobilisation may be an option in selected cases with stable injuries.Īebi M, Etter C, Coscia M (1989) Fractures of the odontoid process: treatment with anterior screw fixation. A thorough assessment of the stability of the odontoid with lateral flexion/extension views or dynamic fluoroscopy is recommended to evaluate the appropriate treatment. According to our findings, stable type II and type III fractures of the odontoid can be successfully treated with non-rigid immobilisation, even if they are displaced. At follow-up 39% of the patients were free of symptoms however, the clinical outcome did not correlate with the radiological findings. The overall fusion rate was 73.7% for type II and 85.7% for type III fractures. Three of these patients were over 65 years old. In 4 nondisplaced fractures (15%) fibrous union was documented. In 20 (77%) of the remaining fractures healing was uneventful. One patient suffered from pulmonary embolism, in two patients (7.7%) with initially minimally displaced fractures, secondary internal stabilisation had to be performed because of persistent instability. The overall complication rate was 11.4% ( n=3). There were 19 (73.1%) type II and 7 (26.9%) type III fractures in 10 (38.5%) of these fractures the odontoid was displaced and/or angulated. Study inclusion was limited to fractures that had a fracture gap of less than 2 mm, an initial antero-posterior displacement of less than 5 mm and angulation of less than 11°, less than 2 mm displacement on lateral flexion/extension views, and were without neurological deficits. In a retrospective analysis we reviewed 26 patients with acute type II and III fractures of the odontoid, treated with a cervical orthosis only. While untreated fractures or fractures treated only with a cervical orthosis seem to have the highest rate of non-union, the need for rigid external stabilisation has never been substantiated. Despite various reports on the management of odontoid fractures, there is no consensus on the subject, and the appropriate treatment still remains controversial. ![]()
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