Type III Odontoid fracture

Case contributed by Sarah AlJahdali

Presentation

Fall outside metro, landed with posterior head/neck on solid object, complains of neck pain

Patient Data

Age: 75 years
Gender: Female
CT

There is a comminuted fracture involving the C2 vertebra.  Specifically, the fracture involves the base of the odontoid and extends to the vertebral body and lateral masses bilaterally, particularly on the right.  There is no significant displacement of the odontoid process and no evidence of central canal stenosis.

The fracture extends to the transverse foramen on the right side and also extends to the lateral atlantoaxial joints, more signficantly on the right where there is slight distraction of the joint.

Case Discussion

In younger patients, odontoid fractures usually result from high-energy trauma, such as motor vehicle or diving accidents. In the elderly, the fracture can occur from lower energy impacts, such as falling from own height. 

Fractures of C2 are the most common cervical spine injuries in the elderly, and most frequently are of the odontoid process.

Anderson and D'Alonzo classification is widely used for classifying odontoid fractures, based on their location, extension and stability. Type III fractures extend from the base of the odontoid into the vertebral body and may involve variable portion of the lateral facets. Type III odontoid fractures are relatively stable with low risk of non-union, if not excessively displaced.

Case co-author: Rehana Jaffer, MD, FRCPC

Case courtesy of Dr. Mathieu Boily

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