Upper Cervical Spine Fractures and Dislocations

Copyright 2008 Spine Care Hong Kong

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

CT SCAN

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

C5 Left Foramen Transversarium Fracture

MRI

CT Repeated @ 2months - Some Fracture Displacement

CT Repeated @ 3 months

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

Dens Fixation

Click to continue

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