C2 Dens Fracture

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FACTS

Recall C2 Axis fracture Types
  1. Odontoid/Dens (15% of all C-spine fractures)
  1. Hangman's (traumatic spondylolisthesis)
  1. Miscellaneous Fx

HPI

 

PHYSICAL EXAM

IMAGING

MRI C-spine with STIR sequences in coronal and axial planes
  • evaluate integrity of transverse ligament. If transverse ligament violated, C1/C2 translation can happen hence cannot do odontoid screw fixation (need C1-C2 fusion)
A/P
Surgical options
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C1-2 PSF
Anterior odontoid screws
Contraindications
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- TAL violation
- simultaneous atlanto-axial joint injuries
- fx line parallel to screw trajectory
- cervical kyphosis
- barrel chest habitus
- obesity
- non-union fractures
Other Notes
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Factors predicting non-union

  1. comminution of dens
  1. displacement ≥ 5 mm
  1. > 40 years old
  1. posteriorly displaced fx
  1. neuro deficits
 
  • Factors necessitating surgical stabilization
  1. displacement ≥ 5mm
  1. prior nonuinion
  1. instability of fracture in rigid immobilization