Type III odontoid fracture treatment
In general, the Type III odontoid fracture is believed to have high healing potential due to the large fracture surface area through cancellous bone 1).
Current studies recommend nonsurgical management of Type III odontoid fractures with union rates of 85%–100% with external immobilization 2) 3) 4) 5) 6) 7).
≈ 90% heal with external immobilization (and analgesics) if adequately maintained for 8–14 weeks.
Halo-vest brace is probably best, fusion rate ≈ 100% in 1 series.
Rigid collar: fusion rate =50–70%; if used, monitor the patient with frequent C-spine x-rays to rule-out nonunion.
Surgery
See Atlantoaxial fusion (C1–2 arthrodesis) and Anterior odontoid screw fixation for surgical options and operative details.
1)
Hanssen AD, Cabanela ME. Fractures of the dens in adult patients. J Trauma.
1987 Aug;27(8):928-34. PubMed PMID: 3612871.
2)
Greene KA, Dickman CA, Marciano FF, Drabier JB, Hadley MN, Sonntag VK. Acute
axis fractures. Analysis of management and outcome in 340 consecutive cases.
Spine (Phila Pa 1976). 1997 Aug 15;22(16):1843-52. PubMed PMID: 9280020.
3)
Müller EJ, Schwinnen I, Fischer K, Wick M, Muhr G. Non-rigid immobilisation of odontoid fractures. Eur Spine J. 2003;12:522–5.
4)
Polin RS, Szabo T, Bogaev CA, Replogle RE, Jane JA. Nonoperative management of types II and III odontoid fractures: The philadelphia collar versus the halo vest. Neurosurgery. 1996;38:450–6.
5)
Patel A, Zakaria R, Al-Mahfoudh R, Clark S, Barrett C, Sarsam Z, et al. Conservative management of type II and III odontoid fractures in the elderly at a regional spine centre: A prospective and retrospective cohort study. Br J Neurosurg. 2015;29:249–53.
6)
Govender S, Grootboom M. Fractures of the dens – The results of non-rigid immobilization. Injury. 1988;19:165–7.
7)
Hadley MN, Dickman CA, Browner CM, Sonntag VK. Acute axis fractures: A review of 229 cases. J Neurosurg. 1989;71(5 Pt 1):642–7.