Type I: Avulsion fracture from tip of odontoid at insertion of alar ligament
Type II: Transverse fracture through base of odontoid
Type III: Oblique fracture extending from base of odontoid into body of C2
IMAGING
General Features
Radiographic Findings
Fluoroscopic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Donnally CJ 3rd et al: The most influential publications in odontoid fracture management. World Neurosurg. 123:41-8, 2019
Iyer S et al: Management of odontoid fractures in the elderly: a review of the literature and an evidence-based treatment algorithm. Neurosurgery. 82(4):419-30, 2018
Wagner SC et al: Controversies in the management of geriatric odontoid fractures. J Orthop Trauma. 31 Suppl 4:S44-8, 2017
Brinckman MA et al: Marrow edema variability in acute spine fractures. Spine J. 15(3):454-60, 2015
Ryken TC et al: Management of isolated fractures of the axis in adults. Neurosurgery. 72 Suppl 2:132-50, 2013
Patel AA et al: Surgical treatment of unstable type II odontoid fractures in skeletally mature individuals. Spine (Phila Pa 1976). 35(21 Suppl):S209-18, 2010
Pryputniewicz DM et al: Axis fractures. Neurosurgery. 66(3 Suppl):68-82, 2010
Smith HE et al: Trends in epidemiology and management of type II odontoid fractures: 20-year experience at a model system spine injury tertiary referral center. J Spinal Disord Tech. 23(8):501-5, 2010
Koech F et al: Nonoperative management of type II odontoid fractures in the elderly. Spine (Phila Pa 1976). 33(26):2881-6, 2008
Shears E et al: Surgical versus conservative management for odontoid fractures. Cochrane Database Syst Rev. (4):CD005078, 2008
Klimo P Jr et al: Cervical spine trauma in the pediatric patient. Neurosurg Clin N Am. 18(4):599-620, 2007
Grauer JN et al: Proposal of a modified, treatment-oriented classification of odontoid fractures. Spine J. 5(2):123-9, 2005
Muller EJ et al: Non-rigid immobilisation of odontoid fractures. Eur Spine J. 12(5):522-5, 2003
Rao PV: Median (third) occipital condyle. Clin Anat. 15(2):148-51, 2002
Sanderson SP et al: Fracture through the C2 synchondrosis in a young child. Pediatr Neurosurg. 36(5):277-8, 2002
v Ludinghausen M et al: The third occipital condyle, a constituent part of a median occipito-atlanto-odontoid joint: a case report. Surg Radiol Anat. 24(1):71-6, 2002
Teo EC et al: Biomechanical study of C2 (axis) fracture: effect of restraint. Ann Acad Med Singapore. 30(6):582-7, 2001
Weisskopf M et al: CT scans versus conventional tomography in acute fractures of the odontoid process. Eur Spine J. 10(3):250-6, 2001
Govender S et al: Fractures of the odontoid process. J Bone Joint Surg Br. 82(8):1143-7, 2000
Swischuk LE et al: Is the open-mouth odontoid view necessary in children under 5 years? Pediatr Radiol. 30(3):186-9, 2000
Vaccaro AR et al: Contemporary management of adult cervical odontoid fractures. Orthopedics. 23(10):1109-13; quiz 1114-5, 2000
Ziai WC et al: A six year review of odontoid fractures: the emerging role of surgical intervention. Can J Neurol Sci. 27(4):297-301, 2000
Schuler TC et al: Natural history of os odontoideum. J Pediatr Orthop. 11(2):222-5, 1991
Hadley MN et al: New subtype of acute odontoid fractures (type IIA). Neurosurgery. 22(1 Pt 1):67-71, 1988
Anderson LD et al: Fractures of the odontoid process of the axis. J Bone Joint Surg Am. 56(8):1663-74, 1974
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
TERMINOLOGY
Synonyms
Dens fracture
Definitions
Type I: Avulsion fracture from tip of odontoid at insertion of alar ligament
Type II: Transverse fracture through base of odontoid
Type III: Oblique fracture extending from base of odontoid into body of C2
IMAGING
General Features
Radiographic Findings
Fluoroscopic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Donnally CJ 3rd et al: The most influential publications in odontoid fracture management. World Neurosurg. 123:41-8, 2019
Iyer S et al: Management of odontoid fractures in the elderly: a review of the literature and an evidence-based treatment algorithm. Neurosurgery. 82(4):419-30, 2018
Wagner SC et al: Controversies in the management of geriatric odontoid fractures. J Orthop Trauma. 31 Suppl 4:S44-8, 2017
Brinckman MA et al: Marrow edema variability in acute spine fractures. Spine J. 15(3):454-60, 2015
Ryken TC et al: Management of isolated fractures of the axis in adults. Neurosurgery. 72 Suppl 2:132-50, 2013
Patel AA et al: Surgical treatment of unstable type II odontoid fractures in skeletally mature individuals. Spine (Phila Pa 1976). 35(21 Suppl):S209-18, 2010
Pryputniewicz DM et al: Axis fractures. Neurosurgery. 66(3 Suppl):68-82, 2010
Smith HE et al: Trends in epidemiology and management of type II odontoid fractures: 20-year experience at a model system spine injury tertiary referral center. J Spinal Disord Tech. 23(8):501-5, 2010
Koech F et al: Nonoperative management of type II odontoid fractures in the elderly. Spine (Phila Pa 1976). 33(26):2881-6, 2008
Shears E et al: Surgical versus conservative management for odontoid fractures. Cochrane Database Syst Rev. (4):CD005078, 2008
Klimo P Jr et al: Cervical spine trauma in the pediatric patient. Neurosurg Clin N Am. 18(4):599-620, 2007
Grauer JN et al: Proposal of a modified, treatment-oriented classification of odontoid fractures. Spine J. 5(2):123-9, 2005
Muller EJ et al: Non-rigid immobilisation of odontoid fractures. Eur Spine J. 12(5):522-5, 2003
Rao PV: Median (third) occipital condyle. Clin Anat. 15(2):148-51, 2002
Sanderson SP et al: Fracture through the C2 synchondrosis in a young child. Pediatr Neurosurg. 36(5):277-8, 2002
v Ludinghausen M et al: The third occipital condyle, a constituent part of a median occipito-atlanto-odontoid joint: a case report. Surg Radiol Anat. 24(1):71-6, 2002