Odontoid fracture (type II)

Case contributed by Gerry Gardner

Presentation

Severe neck pain following fall from standing height onto concrete step. GP presentation 5 weeks post injury.

Patient Data

Age: 85
Gender: Male
X-ray

Ondontoid fracture is noted. 

X-ray

Coned lateral view better demonstrates ondontoid fracture.  

CT

There  is  an  oblique  fracture  through  the  odontoid  peg with  posterior  subluxation  of  C1  and  the  fractured  peg  with  respect to  the  body  of  C2.  The  peg  is  angulated  posteriorly  with  displacement of  approximately  6mm  at  its  base. The  cranio-cervical  canal  remains  widely  patent  with  ample  room for  the  spinal  cord. The  posterior  elements  of  C1  are  congenitally  not  fused  at  least posteriorly  and  on  the  left.   On  the  right  there  is  a  rather irregular  and  slightly  sclerotic  gap  between  the  lamina  and  lateral mass  which  may  well  be  a  genuine  fracture  but  it  is  not  really displaced. The  remainder  of  the  cervical  spine  shows  extensive  spondylosis with  virtual  fusion  of  the  facet  joints  but  no  further fracture.

Case Discussion

The patient was originally treated with painkillers by a locum GP.

On returning to GP 2 weeks later was sent for x-ray as outpatient (further 2-3 week wait). On x-ray had no peg view and was sent home. Was recalled same day when odontoid fracture was reported and had further views and CT.

Treated conservatively. The patient had a follow up CT that showed non union but no further displacement.

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Case information

rID: 13949
Case created: 2nd Jun 2011
Last edited: 10th May 2017
Inclusion in quiz mode: Included

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