Odontoid Fractures

(Anderson& D’Alonzo ’74)
Type 1-oblique # through tip, above transvere ligament
Type 2-base/neck
(Hadley et al.-2A -marked comminution @ base)
Type3-into upper body of C2

*Type 1-rare, may be ass’d with AOD – use simple cervical collar
*Type 2-high rate non-union with conservative management (35-85%) -predictors of non-union: initial displacement >6 mm, posterior displacement, age >40,delay dx > 3 weeks, angulation > 10 degrees
-ORIF for selected type 2, shallow type 3, and most 2A- otherwise use halo vest
-Surgical Indications- initial displacement >6mm, neuro deficit, polytrauma, reliance on a ventilator, union failure after 3 months in halo, inability to tolerate halo
-Surgical Options-anterior odontoid IF, post. atlantoaxial arthrodesis
*Type 3-halo vest x 12 wks (? ORIF for shallow type 3)

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