• Registration
  • Login
JETem
  • Home
  • About
    • Aim and Scope
    • Our Team
    • Editorial Board
    • FAQ
  • Issues
    • Current Issue
    • Ahead of Print
    • Past Issues
  • Visual EM
    • Latest Visual EM
    • Search Visual EM
    • Thumbnail Library
  • For Authors
    • Instructions for Authors
    • Submit to JETem
    • Photo Consent
    • Policies
      • Peer Review Policy
      • Copyright Policy
      • Editorial Policy, Ethics and Responsibilities
      • Conflicts of Interest & Informed Consent
      • Open Access Policy
  • For Reviewers
    • Instructions for JETem Reviewers
    • Interested in Being a JETem Reviewer?
  • Topic
    • Abdominal / Gastroenterology
    • Administration
    • Board Review
    • Cardiology / Vascular
    • Clinical Informatics, Telehealth and Technology
    • Dermatology
    • EMS
    • Endocrine
    • ENT
    • Faculty Development
    • Genitourinary
    • Geriatrics
    • Hematology / Oncology
    • Infectious Disease
    • Miscellaneous
    • Neurology
    • Ob / Gyn
    • Ophthalmology
    • Orthopedics
    • Pediatrics
    • Procedures
    • Psychiatry
    • Renal / Electrolytes
    • Respiratory
    • Toxicology
    • Trauma
    • Ultrasound
    • Wellness
    • Wilderness
  • Modality
    • Curricula
    • Innovations
    • Lectures
    • Oral Boards
    • Podcasts
    • Simulation
    • Small Group Learning
    • Team Based Learning
    • Visual EM
  • Contact Us

Odontoid Fracture: Computed Tomography

Jonathan Peña, MD* and Alisa Wray, MD*

*University of California, Irvine, Department of Emergency Medicine, Orange, CA

Correspondence should be addressed to Alisa Wray, MD at awray@uci.edu

DOI: https://doi.org/10.21980/J8NP4WIssue 1:2
OrthopedicsVisual EM
No ratings yet.
Odontoid Fracture, CT Sagittal. JETem 2016
Odontoid Fracture, CT Coronal. JETem 2016

 

History of present illness:

An 84-year-old male presented with left-sided posterior head, neck, and back pain after a ground level fall. Exam was notable for left parietal scalp laceration and midline cervical spine tenderness with no obvious deformities. He was neurovascularly intact, and placed in an Aspen Collar with strict spine precautions. 

Significant findings:

Computed Tomography (CT) of the cervical spine showed a stable, acute, non-displaced fracture of the odontoid process extending into the body of C2, consistent with a Type III Odontoid Fracture. He was evaluated by orthopedic spine service who recommended conservative, non-operative management.

Discussion:

The cervical spine is composed of seven vertebrae, with C1 and C2 commonly referred to as the Atlas and Axis, respectively. Unique to C2 is a bony prominence, the Odontoid Process (Dens). Hyperextension or hyperflexion injuries can induce significant stress causing fractures. Odontoid fractures comprise approximately 10% of vertebral fractures, and there are three types with varying stability.1                 

Type 1 is the rarest and is a fracture involving the superior segment of the Dens. It is considered a stable fracture. Type 2 is the most common and is a fracture involving the base of the odontoid process, below the transverse component of the cruciform ligament. This fracture is unstable and requires operative stabilization.2 Type 3 odontoid fractures are classified by a fracture of the Odontoid process, as well as the lateral masses of the C2. Determining the stability of a Type III Odontoid fracture requires radiographic evaluation. Strict cervical spine precautions must be adhered to until adequate imaging and surgical consultation is obtained.

Computed tomography of the of cervical spine fractures poses several advantages to plain film radiography due to the ability to view the anatomy in three planes.3 However, if there is concern for ligamentous injury, MRI is the preferred modality.3

Topics:

Computed tomography, CT, cervical spine, cervical spine fracture, odontoid, orthopedics, spine, neurosurgery.

References:

  1. Koller H, Kolb K, Zenner J, Reynolds J, Dvorak M, Acosta F, et al. Study on accuracy and interobserver reliability of the assessment of odontoid fracture union using plain radiographs or CT scans. Eur Spine J. 2009;18(11):1659-1668. doi: 10.1007/s00586-009-1134-2
  2. Takai H, Konstantinidis L, Schmal H, Helwig P, Knöller S, Südkamp N, et al. Oblique axis body fracture: an unstable subtype of Anderson type III odontoid fractures-apropos of two Cases. Case Rep Orthop. 2016;7561682. doi: 10.1155/2016/7561682
  3. Jain N, Verma R, Garga UC, Baruah BP, Jain SK, Bhaskar SN. CT and MR imaging of odontoid abnormalities: a pictorial review. Indian J Radiol Imaging. 2016;26(1):108-119. doi: 10.4103/0971-3026.178358
Icon

Odontoid Fracture - Case Report

1 file(s) 2.9 MB
Download
Icon

Odontoid Fracture - Images

1 file(s) 4.3 MB
Download
CTIssue 1:2

Reviews:

No ratings yet.

Please rate this





5th Finger Dislocation Photograph JETem 2016

Open Dislocation of Fifth Digit

08 Sep, 16
Ectopic Still JETem 2016

Ruptured Ectopic Pregnancy

08 Sep, 16
JETem is an online, open access, peer-reviewed journal-repository for EM educators

Most Viewed

  • Telemedicine Consult for Shortness of Breath Due to Sympathetic Crashing Acute Pulmonary Edema
  • Anticholinergic Toxicity in the Emergency Department
  • The Suicidal Patient in the Emergency Department Team-Based Learning Activity
  • Child Maltreatment Education: Utilizing an Escape Room Activity to Engage Learners on a Sensitive Topic
  • Acute Chest Syndrome

Visit Our Collaborators

About

Education

Learners should benefit from active learning. JETem accepts submissions of team-based learning, small group learning, simulation, podcasts, lectures, innovations, curricula, question sets, and visualEM.

Scholarship

We believe educators should advance through the scholarship of their educational work. JETem gives educators the opportunity to publish scholarly academic work so that it may be widely distributed, thereby increasing the significance of their results.

Links

  • Home
  • Aim and Scope
  • Current Issue
  • For Reviewers
  • Instructions for Authors
  • Contact Us

Newsletter

Sign up to receive updates from JETem regarding newly published issues and findings.

Copyright © 2016 JETem. All rights reserved.