Increased risk of fracture due to bone loss, which is disproportionate at C2 relative to rest of skeleton. Surgery may be required if the fracture has resulted in neurologic symptoms . describes plane of fracture and displacement. This case demonstrates a type 2 odontoid process fracture, a transverse fracture through the base of the dens and represents the most common type of dens fracture. The odontoid peg is central to the stability of the upper cervical spinethe posterior ring of C1 articulates with the anterior odontoid process, and axial rotation at this joint accounts for approximately 60 degrees of rotation. Which vertebrae has odontoid process? He was managed conservatively there. The nonoperative management of Type II odontoid fractures in elderly patients results in fracture stability, by either osseous union or fibrous union in almost all patients. Objective To evaluate the results of the treatment of fresh type II odontoid fractures with closed reduction and percutaneous screw fixation. Fracture of the odontoid process is classified into one of three types, which are type I, type II, or type III . Odontoid fractures are relatively common fractures of the C2 vertebral body (axis) that can be seen in low energy falls in eldery patients and high energy traumatic injuries in younger patients. Type 1: subacute hemorrhage 2: Popcorn lesion 3: chronic hemorrhage 4: multiple punctate microhemorrhages . The bone involved in odontoid fracture is the second vertebra, C2, high up in the neck. The objective of the study was to evaluate the published . Due to the retrospective nature of most published studies, considerable reporting . . Case Discussion. Purpose Analysis of functional outcome of elderly patients with type II odontoid fractures treated conservatively in relation to their radiological outcome. Apr;75(2):99-105. A type II odontoid fracture is a break that occurs through a specific part of C2, the second bone in the neck. Nonoperative management of Type II odontoid fractures in the elderly: Koech F, Ackland HM, Varma DK, Williamson OD, Malham GM; Spine. ma center) with a diagnosis of C-2 fracture between 1994 and 1998. The authors reviewed the medical records, radiographs, and death certificates of 37 patients aged 65 years or older who were diagnosed with type 2 . The joint between C2 and the vertebra above, C1, has an outstanding range of motion. . 2. The decision for surgical treatment in very elderly patients is still controversial. Methods The 86 patients with type B OF were divided into screw group (42 cases, anterior screw internal fixation) and fusion group (44 cases, posterior atlantoaxial fusion) by the treatment . Classification. On admission, each patient was assessed assigning ASA score, modified Rankin Scale (mRS-pre) and Charlson Comorbidity Index . 2-4,6-13,15,19 Over the last 25 years, reports have documented high mortality in this population as a whole and in those patients treated with halo vests in particular. It is an atypical cervical vertebra with unique features and important relations that make it easily recognisable. Introduction. Management of odontoid fracture cannot be standardized till to . Odontoid fracture is a very common cervical injury, accounting approximately for 9% . describes level of fracture line (i.e. Purpose: Analysis of functional outcome of elderly patients with type II odontoid fractures treated conservatively in relation to their radiological outcome. Type II fracture, the most common type of odontoid fracture, is consid-ered relatively unstable. Odontoid fractures occur as a result of trauma to the cervical spine. 85 female with acute sinusitis who had a fall from a seated position in bed to the floor. This retrospective review describes the early morbidity and mortality in the authors' elderly odontoid fracture population. Nonsurgical measures include immobilization, prevent or restrict movement, in a cervical collar or halo vest. Methods A total of 50 geriatric patients with type II odontoid fractures were treated with Aspen/Vista collars. The bone involved in odontoid fracture is the second vertebra, C2, high up in the neck. Odontoid fractures are the commonest injury of the cervical spine in the elderly. Higher risk of nonunion with comminuted fracture, age > 50 or more than 5 mm displacement. Geriatric type II odontoid fractures are attributed to degenerative changes, commonly occur from ground-level falls, and are increasing in incidence due to an aging population. Type II odontoid fractures are potentially unstable with subsequent myelopathy and spinal injury risk. Download Free PDF View PDF. Effendi et al. The best treatment remains unclear because of the morbidity associated with prolonged cervical immobilisation versus the risks of surgical intervention. Overall, 47.1% of the upper cervical fractures were either odontoid or hangman type fractures and 25.1% of patients had multiple cervical fractures (Tables 2 - 4). Pal D, Sell P, Grevitt M: Type II odontoid fractures in the elderly: an. Odontoid fractures were classified into 3 types, and, in a series of 49 fractures, 2 avulsion, 32 body, and 15 basilar fractures were treated and followed for an average of 22 mth (range, 6 mth to . Among the odontoid fracture, type-2 fracture is the most common variety. HangmanC2C3. 8C1C3,C1C2C2C3ROMA . 1 In the elderly, a type II fracture (as classified by Anderson and D'Alonzo) 2 is the commonest odontoid fracture. . Methods From May 2009 to February 2013, 15 cases of fresh Anderson-DAlonzo type odontoid fractures were treated with closed reduction and percutaneous screw fixation. The axis is the second cervical vertebra, commonly called C2. Thirty-six patients aged 65 years or older were consecutively admitted with a diagnosis of C-2 fracture during the years of the study. 3. Currarino triad. Wackenheim clival line. Eleven were males and 4 were . It can be caused by either hyper-flexion or hyperextension mechanisms of injury. The Odontoid process is a projection of the axis, a second cervical vertebra, and joins the main body . 2008 Dec 15;33(26):2881-6. Odontoid fracture accounts for 15% - 20% of all cervical spine injuries. Altre attivit di Antonio The eyebrow supraorbital approach is truly the epitome of . Associated spinal trauma is much less common in elderly patients (4, 11). Bones of the spine are called vertebrae. Still, due to the paucity of evidence the published treatment guidelines are far from equivocal. Huybregts JG, Jacobs WC, Vleggeert-Lankamp CL: The optimal treatment of type II and III odontoid fractures in the elderly: a systematic review. It occurs at the base of the odontoid between Objective To compare the effect of anterior screw fixation and posterior atlantoaxial fusion for the treatment of type B odontoid fracture (OF). This injury is associated with a high incidence of morbidity, mortality and nonunion in the elderly irrespective of mode of treatment. most commonly used. . This case illustrates the decision making considerations when treating a type 2 odontoid fracture in an elderly patient. Odontoid fractures were classified according to the method of Anderson and D'Alonzo.1 Of the 36 patients, 20 had Type II odontoid fractures. A total of 15 patients with an acute . It occurs at the base of the odontoid between the level of the transverse ligament and the C2 vertebral body. What is Type 2 Odontoid fracture? After a systematic . Eur Spine J 2013, 22(1):1-13. Odontoid fractures type II according to Anderson and d’Alonzo are not uncommon in the elderly patients. Odontoid fractures using posterior C1-2 fixation without fusion | Find, read and cite all the research . These fractures have similar biomechanical properties as transverse ligament injuries with loss of the translational restriction of C1 on C2, creating the potential risk for spinal cord injury and severe late craniocervical deformities when . A type 2C is a fracture that extends from antero-inferior to postero-superior and is treated with instrumental fusion of C1 - C2. The three types of odontoid fracture. Type II odontoid fracture is the most common cervical spine fracture in the elderly, and the incidence of this injury is increasing. Should intersect posterior 1/3 of odontoid process Abnormal e g in basilar invagination. A type 2A fracture is minimally displaced and is treated with external immobilisation. Type II fracture, the most common type of odontoid fracture, is considered relatively unstable. Abstract. odontoid fractures in the elderly--relationship to upper cervical spine osteoarthritis. A 45 years old male had a road traffic accident 11 days back in another country. 12. This injury is associated with a high incidence of morbidity, mortality and nonunion in the elderly irrespective of mode of treatment. Radiological tests showed a type II odontoid fracture with displacement of 3 mm (Figure 2). Common dissection of the vertebral artery is seen in 0.01% of cases with head or neck trauma and vertebral fracture is a significant risk factor for a vertebral dissection. Treatment options for type II odontoid fractures can be nonsurgical or surgical. Meta-analyses of the survival from type-2 odontoid fractures among the elderly aged 65 years report better survival for patients who are treated surgically (Hazard ratio (HR) = 0.64) , while this seems to diminish if only those aged 80 years are included . In elderly patients, the focus tends to shift to morbidity and mortality. Is the odontoid process part of the atlas? Type II Odontoid Fracture in Elderly Patients Treated Conservatively: Is Fracture Healing the Goal? Spine 1 marzo 2019 Vedi pubblicazione. Its most prominent feature is the odontoid process (or dens), which is embryologically the body of the atlas (C1) 1, 2. Long-term clinical and . Cureus 10(9): e3335. Functional Outcome After Odontoid Fractures in the Elderly. Surgery may be required if the fracture has resulted in neurologic symptoms . . In younger patients, they are typically the result of high-energy trauma, which occurs as a result of motor vehicle or diving accidents. Abstract. The best treatment remains unclear because of the morbidity associated with prolonged cervical immobilisation versus the risks of surgical intervention. Authored By: Analiz Rodriguez, MD, PhD, FAANS Little Rock,Arkansas University of Arkansas Medical Sciences Case Presentation. A type 2B is displaced and is generally treated with anterior screw fixation. Considerable controversy exists regarding the optimal management of elderly patients with type II odontoid fractures. Methods:We retrospectively performed a chart review of patients over 65 years of age who underwent odontoid screw placement for type II odontoid fractures (2009-2014) and sustained post-operative . This systematic review focuses on the published results of type II odontoid fracture treatment in the elderly with regard to survival, nonunion, and complications. Treatment depends on the location of the fracture within the C2 vertebrae defined by the Anderson and D'Alonzo classification system and the patient's risk factors for nonunion (failed bone healing). In the elderly population, the trauma can occur after lower energy impacts such as falls from a standing position. 7,12 This trend may be . The aim of this study was to assess morbidity and mortality in patients over 90 years of age undergoing CT-guided posterior stabilization for unstable odontoid type II fractures. Geriatric type II odontoid fractures (GOFs) are the most common type of odontoid fracture in the elderly patients. There is uncertainty regarding the consequences of non-union. Odontoid Fractures are relatively common fractures of the C2 (axis) dens that can be seen in low energy falls in elderly patients and high energy traumatic injuries in younger patients. Young - injury secondary to blunt trauma to head or flexion/extension injury. Among the odontoid fracture, type-2 fracture is the most common variety. On admission, each patient was assessed assigning ASA score, modified Rankin Scale (mRS-pre) and Charlson Comorbidity Index . Type II fracture, the most common type of odontoid fracture, is considered relatively unstable. Methods: A total of 50 geriatric patients with type II odontoid fractures were treated with Aspen/Vista collars. Acta Neurochir Suppl 1 gennaio 2019 Vedi pubblicazione. Odontoid fracture accounts for 15% - 20% of all cervical spine injuries. Background:Although surgery may reduce mortality rates from type II odontoid fractures in the elderly population, post-operative dysphagia resulting from screw fixation remains a serious complication. 2018 Robles et al. mortality and outcome following cervical spine injuries in elderly patients. through tip, base, or lateral masses) Roy-Camille classification. Nonsurgical measures include immobilization, prevent or restrict movement, in a cervical collar or halo vest. His CT showed the type II odontoid fracture of C2, C7, L1 transverse process and left radial bone fractures. A type II odontoid fracture is a break that occurs through a specific part of C2, the second bone in the neck. 1,3,4,6 -12 Longer-term outcomes from odontoid . There are two classification systems 5,6. 2012 Odontoid fractures constitute the commonest cervical spinal fracture in the elderly population [].Early mobilization is essential to prevent clinical deterioration from medical comorbidities or other illnesses due to prolonged recumbence with reported 16% 30-day mortality rate [].This has led to a more aggressive posture towards surgical stabilization of unstable type II . Os odontoideum (normal variant) can look like a Type II odontoid fracture on . The odontoid process, or dens, is a superior projecting bony element from the second cervical vertebrae (C2, or the axis). classified fractures of the ring of the axis and proposed treatment strategies, which were modified by Levine and Edwards as well as Josten [2-4]. Case 2. Important prognostic factors for fracture healing (union versus non-union) are the . European Spine Journal. evidence-based narrative review of management. The joint between C2 and the vertebra above, C1, has an outstanding range of motion. has been shown to better correlate with prognosis. Treatment options for type II odontoid fractures can be nonsurgical or surgical. Type II odontoid fractures are the commonest type representing about 65-74% of the odontoid fractures. 4 . Eur Spine J 2011, 20(2):195-204. Management of odontoid fracture cannot be standardized till to date and ideal treatment for type-2 . Request PDF | On Oct 1, 2022, Hirohito Hirata and others published Letter to the Editor. Odontoid type II fractures represent the most common cervical spine injuries in the elderly. C2 odontoid fracture was with posterior displacement as seen in Fig. Associated spinal trauma is much less common in elderly patients (4, 11). Whilst there is no unified definition of 'elderly' within published spine literature, most authors focussing on this injury include patients aged 65 years and above as elderly.3, 4 . Posterior tangential fracture of one (usually lateral) or both femoral condyles . There is a subdivision of type 2 fractures. Anderson and D'Alonzo. INTRODUCTION. The bone involved in odontoid fracture is the second vertebra, C2, high up in the neck. It occurs at the base of the odontoid between the level of . Odontoid fractures are the most common cervical spine fracture in elderly patients and are known to carry a high risk of complications and mortality. A type II odontoid fracture is a break that occurs through a specific part of C2, the second bone in the neck. Fracture through the base of the dens. Bones of the spine are called vertebrae. Odontoid fractures are the most common cervical spine fractures for patients older than 70 years and are the most common of all spinal fractures for patients older than 80. Type II and type III are unstable fractures. 2008 Michael Murphy. Bones of the spine are called vertebrae. There is uncertainty regarding the consequences of non-union. Sacrococcygeal . Odontoid type 2 fracture. Considerable controversy exists regarding the optimal management of elderly patients with type II odontoid fractures. Cervical spine injury in the young child. Mechanism of injury included the following: 58.7% motor vehicle collisions and 41.3% were from falls. Fractures of the dens in patients older than 65 years: direct . . . The first cervical vertebrae (atlas) rotates around the odontoid process to provide the largest single component of lateral rotation of the cervical spine. 3.
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