What's the Diagnosis? By Dr. Erica Schramm

An 18 y/o M restrained driver is rear ended in a high speed MVC.  A cervical collar is placed by EMS. He arrives to the ED complaining of neck pain. His VS are normal and GCS is 15. He has no focal neurologic deficit on exam. A CT of the head and cervcial spine is obtained. What's the diagnosis? (scroll down for answer)




Answer: Type III Odontoid Fracture (nondisplaced)

  • Most common mechanism is hyperflexion and/or hyperextension of the cervical spine
  • Anderson and D'Alonzo classification is most commonly used system
  • Type I- avulsion fracture of the tip of the odontoid; stable, treated with immobilization (rigid collar vs halo)
  • Type II-fracture through the base of the odontoid process; unstable, surgical management indicated (halo may be considered in younger patients)
  • Type III- fracture of the body below the base of the odontoid; stable if nondisplaced, treated w immobilization (rigid collar vs halo)
  • Sugical repair may be indicated in elderly patients who are at risk for aspiration with immobilization, as well as in patients with nonunion following immobilization

 Reference: Williams, Keith D. "Fractures, Dislocations and Fracture-Dislocations of the Spine."  Campbell's Operative Orthopedics. 13e. Elsevier, 2017.