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Odontoid C2 Fracture
Jeffrey S. Ross, MD
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24
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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

                                          1. Brinckman MA et al: Marrow edema variability in acute spine fractures. Spine J. ePub, 2014
                                          2. Ryken TC et al: Management of isolated fractures of the axis in adults. Neurosurgery. 72 Suppl 2:132-50, 2013
                                          3. 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
                                          4. Pryputniewicz DM et al: Axis fractures. Neurosurgery. 66(3 Suppl):68-82, 2010
                                          5. 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
                                          6. Koech F et al: Nonoperative management of type II odontoid fractures in the elderly. Spine (Phila Pa 1976). 33(26):2881-6, 2008
                                          7. Shears E et al: Surgical versus conservative management for odontoid fractures. Cochrane Database Syst Rev. (4):CD005078, 2008
                                          8. Klimo P Jr et al: Cervical spine trauma in the pediatric patient. Neurosurg Clin N Am. 18(4):599-620, 2007
                                          9. Grauer JN et al: Proposal of a modified, treatment-oriented classification of odontoid fractures. Spine J. 5(2):123-9, 2005
                                          10. Muller EJ et al: Non-rigid immobilisation of odontoid fractures. Eur Spine J. 12(5):522-5, 2003
                                          11. Rao PV: Median (third) occipital condyle. Clin Anat. 15(2):148-51, 2002
                                          12. Sanderson SP et al: Fracture through the C2 synchondrosis in a young child. Pediatr Neurosurg. 36(5):277-8, 2002
                                          13. 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
                                          14. Martin-Ferrer S: Odontoid fractures. J Neurosurg. 95(1 Suppl):158-9, 2001
                                          15. Sasso RC: C2 dens fractures: treatment options. J Spinal Disord. 14(5):455-63, 2001
                                          16. Teo EC et al: Biomechanical study of C2 (Axis) fracture: effect of restraint. Ann Acad Med Singapore. 30(6):582-7, 2001
                                          17. Weisskopf M et al: CT scans versus conventional tomography in acute fractures of the odontoid process. Eur Spine J. 10(3):250-6, 2001
                                          18. Govender S et al: Fractures of the odontoid process. J Bone Joint Surg Br. 82(8):1143-7, 2000
                                          19. Swischuk LE et al: Is the open-mouth odontoid view necessary in children under 5 years? Pediatr Radiol. 30(3):186-9, 2000
                                          20. Vaccaro AR et al: Contemporary management of adult cervical odontoid fractures. Orthopedics. 23(10):1109-13; quiz 1114-5, 2000
                                          21. 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
                                          22. Schuler TC et al: Natural history of os odontoideum. J Pediatr Orthop. 11(2):222-5, 1991
                                          23. Hadley MN et al: New subtype of acute odontoid fractures (type IIA). Neurosurgery. 22(1 Pt 1):67-71, 1988
                                          24. 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

                                                                                  1. Brinckman MA et al: Marrow edema variability in acute spine fractures. Spine J. ePub, 2014
                                                                                  2. Ryken TC et al: Management of isolated fractures of the axis in adults. Neurosurgery. 72 Suppl 2:132-50, 2013
                                                                                  3. 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
                                                                                  4. Pryputniewicz DM et al: Axis fractures. Neurosurgery. 66(3 Suppl):68-82, 2010
                                                                                  5. 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
                                                                                  6. Koech F et al: Nonoperative management of type II odontoid fractures in the elderly. Spine (Phila Pa 1976). 33(26):2881-6, 2008
                                                                                  7. Shears E et al: Surgical versus conservative management for odontoid fractures. Cochrane Database Syst Rev. (4):CD005078, 2008
                                                                                  8. Klimo P Jr et al: Cervical spine trauma in the pediatric patient. Neurosurg Clin N Am. 18(4):599-620, 2007
                                                                                  9. Grauer JN et al: Proposal of a modified, treatment-oriented classification of odontoid fractures. Spine J. 5(2):123-9, 2005
                                                                                  10. Muller EJ et al: Non-rigid immobilisation of odontoid fractures. Eur Spine J. 12(5):522-5, 2003
                                                                                  11. Rao PV: Median (third) occipital condyle. Clin Anat. 15(2):148-51, 2002
                                                                                  12. Sanderson SP et al: Fracture through the C2 synchondrosis in a young child. Pediatr Neurosurg. 36(5):277-8, 2002
                                                                                  13. 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
                                                                                  14. Martin-Ferrer S: Odontoid fractures. J Neurosurg. 95(1 Suppl):158-9, 2001
                                                                                  15. Sasso RC: C2 dens fractures: treatment options. J Spinal Disord. 14(5):455-63, 2001
                                                                                  16. Teo EC et al: Biomechanical study of C2 (Axis) fracture: effect of restraint. Ann Acad Med Singapore. 30(6):582-7, 2001
                                                                                  17. Weisskopf M et al: CT scans versus conventional tomography in acute fractures of the odontoid process. Eur Spine J. 10(3):250-6, 2001
                                                                                  18. Govender S et al: Fractures of the odontoid process. J Bone Joint Surg Br. 82(8):1143-7, 2000
                                                                                  19. Swischuk LE et al: Is the open-mouth odontoid view necessary in children under 5 years? Pediatr Radiol. 30(3):186-9, 2000
                                                                                  20. Vaccaro AR et al: Contemporary management of adult cervical odontoid fractures. Orthopedics. 23(10):1109-13; quiz 1114-5, 2000
                                                                                  21. 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
                                                                                  22. Schuler TC et al: Natural history of os odontoideum. J Pediatr Orthop. 11(2):222-5, 1991
                                                                                  23. Hadley MN et al: New subtype of acute odontoid fractures (type IIA). Neurosurgery. 22(1 Pt 1):67-71, 1988
                                                                                  24. Anderson LD et al: Fractures of the odontoid process of the axis. J Bone Joint Surg Am. 56(8):1663-74, 1974