# Odontoid fractures

Odontoid fractures

There are three types of  odontoid peg fracture ( Figure 30.27 ). Neurological injury is rare. The majority of  acute injuries are treated non-operatively in a hard collar or halo jacket for 3 /uni00A0 months. Internal fixation with an anterior compression screw is indicated for displaced fractures ( Figure 30.28 ), and a posterior C1/2 fusion is considered in cases of  non-union. In the elderly , treatment in a soft collar should be considered on the basis that a relatively stable pseudarthrosis will occur. Traumatic spondylolisthesis of the axis (hangman’s fracture) This is a traumatic spondylolisthesis of  C2 on C3. There are four types with varying degrees of  instability ( Figure 30.29 ). Those with significant displacement or associated facet disloca - tion are treated operatively , usually with posterior stabilisation. 

(b)
Figure 30.26
(a)
Atlantoaxial subluxation.
(b)
C1/2 posterior fusion
using C1 lateral mass and C2 pedicle screws.
Type I
Type II
Type III
Figure 30.27
Types of odontoid fracture.
(b)
Figure 30.28
(a)
Type II odontoid fracture (arrow);
(b)
treated with an
anterior compression screw.



(b)
Figure 30.29
(a)
Hangman’s fractures of C2 with minimal forward
translation (arrow).
(b)
C2/3 subluxation with spinal cord contusion.

Odontoid fractures

There are three types of  odontoid peg fracture ( Figure 30.27 ). Neurological injury is rare. The majority of  acute injuries are treated non-operatively in a hard collar or halo jacket for 3 /uni00A0 months. Internal fixation with an anterior compression screw is indicated for displaced fractures ( Figure 30.28 ), and a posterior C1/2 fusion is considered in cases of  non-union. In the elderly , treatment in a soft collar should be considered on the basis that a relatively stable pseudarthrosis will occur. Traumatic spondylolisthesis of the axis (hangman’s fracture) This is a traumatic spondylolisthesis of  C2 on C3. There are four types with varying degrees of  instability ( Figure 30.29 ). Those with significant displacement or associated facet disloca - tion are treated operatively , usually with posterior stabilisation. 

(b)
Figure 30.26
(a)
Atlantoaxial subluxation.
(b)
C1/2 posterior fusion
using C1 lateral mass and C2 pedicle screws.
Type I
Type II
Type III
Figure 30.27
Types of odontoid fracture.
(b)
Figure 30.28
(a)
Type II odontoid fracture (arrow);
(b)
treated with an
anterior compression screw.



(b)
Figure 30.29
(a)
Hangman’s fractures of C2 with minimal forward
translation (arrow).
(b)
C2/3 subluxation with spinal cord contusion.

Odontoid fractures

There are three types of  odontoid peg fracture ( Figure 30.27 ). Neurological injury is rare. The majority of  acute injuries are treated non-operatively in a hard collar or halo jacket for 3 /uni00A0 months. Internal fixation with an anterior compression screw is indicated for displaced fractures ( Figure 30.28 ), and a posterior C1/2 fusion is considered in cases of  non-union. In the elderly , treatment in a soft collar should be considered on the basis that a relatively stable pseudarthrosis will occur. Traumatic spondylolisthesis of the axis (hangman’s fracture) This is a traumatic spondylolisthesis of  C2 on C3. There are four types with varying degrees of  instability ( Figure 30.29 ). Those with significant displacement or associated facet disloca - tion are treated operatively , usually with posterior stabilisation. 

(b)
Figure 30.26
(a)
Atlantoaxial subluxation.
(b)
C1/2 posterior fusion
using C1 lateral mass and C2 pedicle screws.
Type I
Type II
Type III
Figure 30.27
Types of odontoid fracture.
(b)
Figure 30.28
(a)
Type II odontoid fracture (arrow);
(b)
treated with an
anterior compression screw.



(b)
Figure 30.29
(a)
Hangman’s fractures of C2 with minimal forward
translation (arrow).
(b)
C2/3 subluxation with spinal cord contusion.