Odontoid fracture type II

• Traumatic posterior atlantoaxial dislocation based on imaging of the anterior arch-odontoid process-transverse ligament complex: a retrospective cohort study
• Hounsfield unit measurements to predict odontoid fracture union in elderly patients: post-hoc subgroup analysis from an international prospective comparative study
• Traumatic odontoid fracture - Proposal of a treatment algorithm
• The AO Spine Upper Cervical Injury Classification System (AO UCIC) - An Umbrella Review of Traumatic Axis Injuries Factors that May Affect Treatment Decision
• Safety of non-osseous union of type II odontoid fractures-a multi-institutional cohort study
• Odontoid process type II and III fracture fixation using bone allograft screws versus cannulated screws: a biomechanical study
• Full-endoscopic assisted surgery using anterior double odontoid screw fixation in type II odontoid fractures: A clinical study of the surgical technique
• Outcome of Conservative Treatment of Odontoid Fractures in Elderly Patients Over 80 Years Old

It is an unstable odontoid fracture at the base of the odontoid, with a high risk of non-union.

Precise differentiation is difficult between low type II and high type III fractures.

There is a lack of distinction between fractures in terms of fracture line obliquity, displacement, and comminution which has an impact on subsequent management.

To address this limitation, Hadley et al. ¹⁾ introduced a type IIA fracture subclass to the classification, defined as a type II fracture complicated by an additional chip-fracture fragment at the anterior or posterior aspect of the base of the odontoid.

Grauer subclassification of Anderson D'Alonzo Type II Odontoid fracture

82% of patients with Type II fractures in a review of 7 reports in the literature were neurologically intact, 8% had minor deficits of scalp or limb sensation, and 10% had significant deficits (ranging from monoparesis to quadriplegia) ²⁾.

see Odontoid fracture type II treatment

Type II odontoid fractures have been associated with limited healing potential, and both nonoperative and operative management are associated with high mortality rates. Historically, there has been some debate in the literature about optimal management strategies to maximize outcomes in geriatric patients. Recent, high-quality evidence has indicated that surgical treatment of type II odontoid fractures in elderly patients is associated with improvements in both short- and long-term mortality. Additionally, surgical intervention has been shown to improve functional outcomes when compared with nonsurgical treatment. Factors to consider before surgery for geriatric type II odontoid fractures include associated comorbidities and the safety of general anesthesia administration. With appropriate measures of patient selection, surgery can provide an efficacious option for geriatric patients with type II odontoid fractures. We recommend surgical intervention via a posterior C1-C2 arthrodesis for geriatric type II odontoid fractures, provided that the surgery itself does not represent an unreasonable risk for mortality ³⁾.

A systematic review of literature published between January 1, 2000, and February 1, 2015, related to the treatment of type II odontoid fractures in patients >60 years of age. An analysis of short-term mortality, long-term mortality, and the occurrence of complications was performed.

A total of 452 articles were identified, of which 21 articles with 1233 patients met the inclusion criteria. Short-term mortality (odds ratio, 0.43; 95% confidence interval, 0.30-0.63) and long-term mortality (odds ratio, 0.47; 95% confidence interval, 0.34-0.64) were lower in patients who underwent surgical treatment than in those who had nonsurgical treatment, and there were no significant differences in the rate of complications (odds ratio, 1.01; 95% confidence interval, 0.63-1.63). The surgical approach (posterior vs anterior) showed no significant difference in mortality or complication rate. Similarly, no difference in mortality or complication rate was identified with a hard collar or a halo orthosis immobilization.

The current literature suggests that well-selected patients >60 years of age undergoing surgical treatment for a type II odontoid fracture have a decreased risk of short-term and long-term mortality without an increase in the risk of complications ⁴⁾.

A total of 45 patients with odontoid fractures (55.6% of the patients with type II odontoid fractures and 44.4% of patients with type III) received halo vest treatment. In the present study, in type II odontoid fractures, the union was achieved in 15.6% of patients, 28.9% of patients had malunion and 11.1% had nonunion. In type III odontoid fractures, union cases comprised 15.6% of patients, while malunion cases accounted for 28.9% of patients and nonunion cases were found in 4.4% of the patients.

Conclusion: The halo vest management for type II and III odontoid fracture requires a prolonged course of cervical immobilization. Multiple factors contribute to the alteration of the management protocol, patient adherence, and difficulties related to HV, and a significant rate of reduction loss ultimately results in malunion or nonunion ⁵⁾.

Frati et al. report the combined triple C1-C2 fixation technique with manual reduction of the joint masses during patient positioning on the operating table, which allowed for effective stabilization during a single surgical session. They describe the experience in the management of a 75-year-old patient presenting with an acute complex type II C1 fracture, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis.

They provide a step-by-step guide for combined triple C1-C2 anterior fixation with manual fracture reduction and describe the clinical case of an acute complex type II fracture of C1, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis.

Combined triple C1-C2 fixation represents a safe and efficient minimally invasive anterior approach for complex type II fractures of C1 with type II odontoid fractures. Manual reduction of the joint masses during patient positioning allows for effective stabilization in a single surgical session ⁶⁾