Early immobilization followed by surgical decompression and stabilization is primordial. Attributable to the kinetic the bone fracture of the Atlas and Axis are commonly related, especially the odontoid process. The disruption of the atlantoaxial ligaments originates the considered most unstable cervical spine lesion and with the highest mortality. The atlantoaxial joint dislocation is a rare condition of the upper cervical spine and is usually secondary to a high-energy traumatism. Case reportsĪ young woman who suffered a severe polytrauma secondary to a motor vehicle collision was diagnosed with a sagittal plane atlantoaxial joint dislocation associated with a type III odontoid fracture, despite adequate initial polytrauma management, the neurological damage was too critical, ultimately the decease of the patient. For complex Type III fractures, they recommended initial conservative treatment, while maintaining close monitoring throughout patient recovery and fracture union 4). In the current study, 21% of patients were unsuccessfully treated nonoperatively with external immobilization and required surgery. No statistical advantage of halo vest versus hard collar orthosis was observed.Ĭomplex Type III odontoid fractures are distinctly different from low-energy injuries. Initial fracture displacement and angulation were not correlative with final outcome. Two additional patients required delayed surgery for nonunion and myelopathy. Seven patients demonstrated progressive displacement of either 2 mm of translation or 5° of angulation and underwent delayed surgical stabilization. Thirty-three patients met the inclusion and exclusion criteria including 15 patients treated in a halo vest and 18 in a hard collar orthosis. One hundred and twenty-five Type III odontoid fractures were identified with 51% classified as complex fractures. Patients were treated in either a hard collar orthosis or halo vest and were followed for fracture union and stability. Fractures were categorized as high- or low-energy fracture with high-energy fractures defined as those with lateral mass comminution (>50%) or secondary fracture lines into the pars interarticularis or vertebral body. Case seriesĪcute Type III odontoid fractures were identified at a single institution from 2008 to 2015. Always check the coronal view, which more readily demonstrates the relationship of the fracture to the VB. A type III odontoid fracture may be misinterpreted as odontoid fracture type II on sagittal CT because the fracture may appear to lie above the vertebral body ( VB). In general, the Type III fracture is believed to have high healing potential due to the large fracture surface area through cancellous bone 3). Biomechanically, complex fractures exhibit the same deforming forces as all odontoid fractures with additional instability in the rotatory or coronal plane 2). At trauma centers, a complex, high-energy subtype exists that radiographically fits the definition of Type III odontoid fracture but of unknown clinical context.įractures with >50% comminution of the lateral mass or secondary fracture lines extending into the vertebral body or pars interarticularis were classified as complex by Niemeier et al. In clinical practice, the Type III fracture encompasses a heterogeneous collection of morphologically different fractures of varying etiologies and patient demographics. The difference is where the fracture line occurs. Type III odontoid fractures occur secondary to hyperextension or hyperflexion of the cervical spine in a similar manner to type II odontoid fractures. Type III fractures account for 39% of all odontoid fractures 1). A type III odontoid fracture is a fracture through the body of the C2 vertebrae and may involve a variable portion of the C1 and C2 facets.
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