Odontoid fracture - Revision history

Rossdonaldson1: /* Differential Diagnosis */

2020-10-24T13:17:30Z

Differential Diagnosis

← Older revision		Revision as of 13:17, 24 October 2020
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	==Differential Diagnosis==		==Differential Diagnosis==
			{{Blunt neck trauma DDX}}

	==Evaluation==		==Evaluation==

Rossdonaldson1 at 13:11, 24 October 2020

2020-10-24T13:11:14Z

← Older revision		Revision as of 13:11, 24 October 2020
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	*'''Type III:''' Extension of the fracture through upper portion of body of C2		*'''Type III:''' Extension of the fracture through upper portion of body of C2
	**Unstable fracture		**Unstable fracture

			{{Vertebral fractures and dislocations types}}

	==Clinical Features==		==Clinical Features==
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	==Differential Diagnosis==		==Differential Diagnosis==
	~~{{Cervical spine injuries}}~~

	==Evaluation==		==Evaluation==

SLuckettG: /* Disposition */

2019-03-25T15:00:32Z

Disposition

← Older revision		Revision as of 15:00, 25 March 2019
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	==Disposition==		==Disposition==
	*Admit		*Admit
	*May consider discharge with hard cervical collar for Type I fracture (stable)~~. Must be done~~ in consultation with spine surgery.<ref name="Waterbrook">Waterbrook, A. (2016). Sports medicine for the emergency physician: a practical handbook. Cambridge: Cambridge University Press.</ref>		*May consider discharge with hard cervical collar for Type I fracture (stable)
			**Consider only in consultation with spine surgery service<ref name="Waterbrook">Waterbrook, A. (2016). Sports medicine for the emergency physician: a practical handbook. Cambridge: Cambridge University Press.</ref>

	==See Also==		==See Also==

SLuckettG: /* Background */

2019-03-25T14:59:49Z

Background

← Older revision		Revision as of 14:59, 25 March 2019
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	**Young - injury secondary to blunt trauma to head or flexion/extension injury		**Young - injury secondary to blunt trauma to head or flexion/extension injury
	**Elderly - injury secondary to fall, higher morbidity/mortality than young patients		**Elderly - injury secondary to fall, higher morbidity/mortality than young patients
			***Increased risk of fracture due to bone loss, which is disproportionate at C2 relative to rest of skeleton
	*Frequently associated with other cervical spine injuries		*Frequently associated with other cervical spine injuries
	*25% associated with neurologic injury/deficit		*25% associated with neurologic injury/deficit
	*Os odontoideum (normal variant) can look like a Type II odontoid fracture on imaging, causing false postive.		*Os odontoideum (normal variant) can look like a Type II odontoid fracture on imaging, causing false postive

	===Types===		===Types===
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	*'''Type II:''' Fracture at base of odontoid where it meets C2 body		*'''Type II:''' Fracture at base of odontoid where it meets C2 body
	**Unstable fracture		**Unstable fracture
	**High risk of nonunion due to interruption of blood supply		**High risk of nonunion (30%) due to interruption of blood supply
	*'''Type III:''' Extension of the fracture through upper portion of body of C2		*'''Type III:''' Extension of the fracture through upper portion of body of C2
	**Unstable fracture		**Unstable fracture

Mholtz at 09:25, 8 September 2017

2017-09-08T09:25:44Z

← Older revision		Revision as of 09:25, 8 September 2017
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	===Types===		===Types===
	*Type I: Oblique avulsion fracture of tip of odontoid; alar ligament avulsion		*'''Type I:''' Oblique avulsion fracture of tip of odontoid; alar ligament avulsion
	**Stable		**Stable fracture
	**Atlanto-occipital instability (AAI) should be ruled out with flexion and extension films		*'''Type II:''' Fracture at base of odontoid where it meets C2 body
	**AAI requires surgical management		**Unstable fracture
	*Type II: Fracture at base of odontoid ~~process~~ where it ~~attaches to~~ C2~~; Fracture through waist~~		**High risk of nonunion due to interruption of blood supply
	**Unstable		*'''Type III:''' Extension of the fracture through upper portion of body of C2
	**High nonunion ~~rate~~ due to interruption of blood supply		**Unstable fracture
	***Young: Halo if no risk factors for nonunion, Surgery if risk factors for nonunion
	***Elderly: Collar if not surgical candidates, Surgery if surgical candidates
	*Type III: Extension of the fracture through upper portion of body of C2
	**Unstable

	==Clinical Features==		==Clinical Features==
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	==See Also==		==See Also==
	*[[Cervical spine ~~injuries~~]]		*[[Cervical spine fractures and dislocations]]

	==References==		==References==

Mholtz at 09:22, 8 September 2017

2017-09-08T09:22:46Z

← Older revision		Revision as of 09:22, 8 September 2017
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	==Background==		==Background==
	*Also known as dens fracture[[File:Odontoid Fractures.jpg\|right\|thumbnail\|The three types of odontoid fracture. Type II and type III are [[Unstable spine fractures\|unstable fractures]].]]		[[File:Odontoid Fractures.jpg\|right\|thumbnail\|The three types of odontoid fracture. Type II and type III are [[Unstable spine fractures\|unstable fractures]].]]
	*Only stable if type I: confined to avulsion of the tip (superior to transverse ligament)<ref>Clark, J., Abdullah, K. and Mroz, T. (2011) Biomechanics of the Craniovertebral Junction. Edited by Vaclav Klika</ref>
	*Bimodal distribution
	**Young - blunt trauma to head, flexion/extension injury
	**Elderly - fall, with higher morbidity/mortality
	*False positives
	**Dens and vertebral body are connected by cartilage at young age, and do not fuse until 3-6 years of age (up to 11 years of age)
	**Os odontoideum - normal variant

	~~==Clinical Features==~~		*Fracture of C2 (dens)
	*Frequently ~~involves~~ other cervical spine injuries		*Bimodal age distribution
	*25% associated with neurologic injury		**Young - injury secondary to blunt trauma to head or flexion/extension injury
			**Elderly - injury secondary to fall, higher morbidity/mortality than young patients
	~~==Differential Diagnosis==~~		*Frequently associated with other cervical spine injuries
	~~{{Cervical spine injuries}}~~		*25% associated with neurologic injury/deficit
			*Os odontoideum (normal variant) can look like a Type II odontoid fracture on imaging, causing false postive.
	~~==Evaluation==~~
	*~~Imaging~~
	**Xray: AP, lateral, open-mouth odontoid ~~view of cervical spine~~
	**CT for further assessment if fracture ~~identified~~

	===Types===		===Types===
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	*Type III: Extension of the fracture through upper portion of body of C2		*Type III: Extension of the fracture through upper portion of body of C2
	**Unstable		**Unstable

			==Clinical Features==
			*Neck pain
			*May have neurologic deficit

			==Differential Diagnosis==
			{{Cervical spine injuries}}

			==Evaluation==
			*CT is the imaging study of choice
			*Cervical spine x-ray may be performed if CT unavailable
			**Must include open-mouth odontoid view

	==Management==		==Management==
	*~~Observation for:~~		*Cervical spine motion restriction via hard cervical collar
	**Os odontoideum		*Consult spine surgery
	**No neuro deficits
	*Hard C-collar ~~for 6-12 wks for:~~
	**Type 1 and 2 non-surgical candidates
	**Partial fibrous union
	*Prehospital Immobilization see [[EBQ:Prehospital Spine Immobilization\|NAEMSP National Guidelines for Spinal Immobilization]]
	*Consult ~~ortho/neurosurgery/trauma~~

	==Disposition==		==Disposition==
			*Admit
			*May consider discharge with hard cervical collar for Type I fracture (stable). Must be done in consultation with spine surgery.<ref name="Waterbrook">Waterbrook, A. (2016). Sports medicine for the emergency physician: a practical handbook. Cambridge: Cambridge University Press.</ref>

	==See Also==		==See Also==

Ravillaa: /* Types */

2017-08-07T17:40:41Z

Types

← Older revision		Revision as of 17:40, 7 August 2017
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	*Type II: Fracture at base of odontoid process where it attaches to C2; Fracture through waist		*Type II: Fracture at base of odontoid process where it attaches to C2; Fracture through waist
	**Unstable		**Unstable
	**~~high~~ nonunion rate due to interruption of blood supply		**High nonunion rate due to interruption of blood supply
	***Young: Halo if no risk factors for nonunion, Surgery if risk factors for nonunion		***Young: Halo if no risk factors for nonunion, Surgery if risk factors for nonunion
	***Elderly: Collar if not surgical candidates, Surgery if surgical candidates		***Elderly: Collar if not surgical candidates, Surgery if surgical candidates

Chungirv: /* Background */

2017-08-07T17:14:42Z

Background

← Older revision		Revision as of 17:14, 7 August 2017
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	==Background==		==Background==
	*Also known as dens fracture		*Also known as dens fracture[[File:Odontoid Fractures.jpg\|right\|thumbnail\|The three types of odontoid fracture. Type II and type III are [[Unstable spine fractures\|unstable fractures]].]]
	*Only stable if ~~fracture~~ confined to avulsion of the tip (superior to transverse ligament)<ref>Clark, J., Abdullah, K. and Mroz, T. (2011) Biomechanics of the Craniovertebral Junction. Edited by Vaclav Klika</ref>		*Only stable if type I: confined to avulsion of the tip (superior to transverse ligament)<ref>Clark, J., Abdullah, K. and Mroz, T. (2011) Biomechanics of the Craniovertebral Junction. Edited by Vaclav Klika</ref>
	*Bimodal distribution		*Bimodal distribution
	**Young - blunt trauma to head, flexion/extension injury		**Young - blunt trauma to head, flexion/extension injury

Neil.m.young: Text replacement - "yoa" to "years of age"

2016-07-30T11:38:18Z

Text replacement - "yoa" to "years of age"

← Older revision		Revision as of 11:38, 30 July 2016
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	**Elderly - fall, with higher morbidity/mortality		**Elderly - fall, with higher morbidity/mortality
	*False positives		*False positives
	**Dens and vertebral body are connected by cartilage at young age, and do not fuse until 3-6 ~~yoa~~ (up to 11 ~~yoa~~)		**Dens and vertebral body are connected by cartilage at young age, and do not fuse until 3-6 years of age (up to 11 years of age)
	**Os odontoideum - normal variant		**Os odontoideum - normal variant

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-24T10:50:30Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 10:50, 24 July 2016
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	{{Cervical spine injuries}}		{{Cervical spine injuries}}

	==~~Diagnosis~~==		==Evaluation==
	*Imaging		*Imaging
	**Xray: AP, lateral, open-mouth odontoid view of cervical spine		**Xray: AP, lateral, open-mouth odontoid view of cervical spine