Odontoid Fractures: Current Concepts and Treatments

Odontoid Fractures: A Standard Review of Current Concepts and Treatment Recommendations

Ali Nourbakhsh, MD; Zachary C. Hanson, MD

Disclosures

J Am Acad Orthop Surg. 2022;30(6):e561-e572. 

In This Article

Abstract and Introduction

Abstract

Odontoid fractures represent the most common fractures involving C2 and the most common cervical spine fractures in patients older than 65 years. Despite their increasing frequency, optimal management of these injuries remain a subject to debate. Although types I and III injuries have relatively good healing potential with nonsurgical treatment, type II fractures carry a higher risk for nonunion. In particular, elderly patients are at risk for nonunion or fibrous malunion after nonsurgical treatment; however, increased medical comorbidities and poor bone quality also increase the risks of surgery in this cohort. The high morbidity and mortality associated with these injuries has made it an area of particular interest among spine surgeons. The purpose of this review was to summarize the pathophysiology, evaluation, and diagnosis of these injuries and to review controversies in management and considerations for treatment based on the most recent available literature.

Introduction

Odontoid fractures are the most common fractures of the axis (C2), representing approximately 10% to 20% of all cervical spine injuries, and are the most common type of cervical spine fracture in patients older than 65 years.[1,2]Odontoid fractures are reaching epidemic proportions among elderly patients, with an incidence growing faster than that of any other spine fractures.

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