![]() ![]() Type-II odontoid fractures are associated with higher nonunion rates compared with Type I and Type III. The review aimed to examine the evidence from randomised controlled trials comparing surgical versus conservative treatment for these fractures to find if either approach gave a better outcome. Odontoid fractures are common cervical spine fractures with a bimodal age distribution, which is gradually shifting to more representation in the elderly population. Another option is surgical stabilisation of the fractured parts. ![]() People with these fractures are often treated conservatively, which entails stabilisation of the neck in devices such as a 'Halo' (external frame) and/or rigid collar for several months. In survivors there is a risk of ongoing damage to the spinal cord and paralysis. Fracture of the odontoid process is a serious injury and is often fatal. Underneath this is the axis or second vertebra, which has a upward pointing process called the odontoid process around which the atlas can rotate, enabling the head to be turned. The first vertebra, called the atlas, supports the skull. The high levels of morbidity and mortality associated with odontoid fractures should encourage all providers to pursue medical co-management and optimization of bone health following diagnosis.The seven bones making up the neck region of the backbone are called the cervical vertebrae. Type III: fracture extends into the body of the axis. Type II: fracture through the base of the dens, at the junction of the odontoid base and the body of C2. If operative management is chosen, a posterior approach is should be chosen when fracture- or patient-related factors make an anterior approach challenging. Epidemiology /Etiology Type I: avulsion fracture of the apex. Synonyms Dens fracture Definitions Type I: Avulsion fracture from tip of odontoid at insertion of alar ligament Type II: Transverse fracture through. In a frail elderly patient, a fibrous nonunion with close follow-up is an acceptable outcome. The cerebral magnetic resonance imaging performed showed a fracture at the base of the odontoid process (green arrow) without displacement and small anterior. However, the risks of surgery in an elderly population must be carefully considered on a case-by-case basis. Type II fractures with any additonal risk factors for nonunion (displacement, comminution, etc) should be considered for surgical management. We believe that type I and type III odontoid fractures can be managed in a collar in most cases. A treatment algorithm is presented based on the available literature. The merits of operative vs nonoperative management, fibrous union, and the choice of operative approach in elderly patients are discussed. We provide a review of the existing literature and discuss the classification and evaluation of odontoid fractures. Poor bone health and medical comorbidities contribute to increased surgical risk in this population however, nonoperative management is associated with a risk of nonunion or fibrous union. Despite their frequency, there is considerable ambiguity regarding optimal management strategies for these fractures in the elderly. Odontoid fractures are the most common fracture of the axis and the most common cervical spine fracture in patients over 65. ![]()
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