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Upper Cervical Spine Fractures and Dislocations |
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Copyright © 2008 Spine Care Hong Kong |
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Odontoid (Dens) Fractures Odontoid fractures are the most common fractures of C2. About 10-15% of all cervical spine fractures. In children, these consitute about 75% of all cervical spine injuries. Male to Female ratio approx 3:1, most are under 40 years of age. Number of cases has increased over last 50 years, probably because of an increase in high speed motor vehicle accidents. Acute C2 fractures represent 7-17% of all cervical spine fractures in most large series. 40% are associated with head injuries, and 15-20% are associated with additional cervical spine injuries.
Mechanism Over 60 years, falls are commonest Under 40 years, MVA is commonest cause.
Case Illustration:
Male late fifties Fell off a ladder main complaint of severe neck pain right side worse than left Brought to Casualty Department Examination revealed severe upper neck pain No neurological deficit |
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CT SCAN |
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Type 2-3 fracture dens (undisplaced) Fracture lateral mass through foramen transversarium right C5
Management Options explained to patient Conservative – external bracing Operative – fracture fixation Agree for conservative Rx SOMI brace prescribed |
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C5 Left Foramen Transversarium Fracture |
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MRI |
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CT Repeated @ 2months - Some Fracture Displacement |
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CT Repeated @ 3½ months |
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DIAGNOSIS Delayed Union dens fracture
In SOMI brace for total 4 months Options explained Continue to wear SOMI brace Surgery for odontoid fixation with dens (odontoid) screw |
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Dens Fixation |
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SPINE CARE HONG KONG |
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ACCURATE DIAGNOSIS, STRUCTURED TREATMENT |
