![]() Trauma accounts for majority of odontoid fractures. Rates of mortality following odontoid fractures in the elderly population have been reported to be as high as 30%. While many types of odontoid fractures can be treated conservatively, surgical intervention including posterior C1–C2 fusion and anterior odontoid screws, are options for the management of unstable fractures or those unlikely to heal with external immobilization alone. Odontoid fractures generally are classified based on their anatomical fracture patterns. Odontoid fractures more frequently affect men with a sex ratio of nearly 3:1. 1 These most commonly occur in older adults and the prevalence is increasing substantially with the growth rate of the elderly population. Odontoid fractures range from 10 to 20% of cervical spine fractures. Keywords: odontoid fractures, hangman fractures, C1–C2 fusion, external immobilizationĭue to the unique biomechanics of the C1 region, the upper cervical spine is highly susceptible to bony fractures and ligamentous injuries following trauma, which can lead to fracture of the dens. This chapter will review odontoid and hangman’s fractures resulting from cervical trauma with a focus on clinical decision-making regarding definitive management. In the setting of trauma, quick evaluation with physical examination and radiographic identification of axis fractures can help safely direct management including operative and nonoperative techniques and achieve successful functional outcomes for the patient. Fractures of the axis are common traumatic injuries of the cervical spine that present as challenging clinical problems for both patients and practitioners.
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