The treatment of odontoid fractures with a significant displacement

The purpose of this study was to determine the treatment features of odontoid fractures with a significant displacement.

Thirty-seven patients with acute odontoid fractures were treated in Kaunas University of Medicine Hospital between 1998 and 2003. Seventeen persons with displacement of fragments less than 5 mm or 5 mm (according to E. A. Seybold and J. C. Bayley method) were in the first group. Twenty patients with displacement of fragments more than 5 mm were in the second group. The attempt of closed reduction of the cervical spine axis was performed for all patients. If successful closed reduction was achieved, patients were placed in halo-vest device for 8 weeks. If closed reduction failed, patient was operated according to W. E. Gallie. Postoperatively, all patients wore a halo-vest device during the first 8 weeks.

Demographics including age, sex, neurological condition, and associated spinal fractures were similar in patients from these groups (p>0.05). Successful closed reduction of the cervical spine axis was achieved in 11 (64.7%) patients from the first group and in 13 (65%) patients from the second group (p>0.05). Six (35.3%) patients from the first group and seven (35%) from the second group were treated with immediate C1-C2 posterior fusion (p>0.05). Two (16.7%) from twelve patients from the second group were treated by external immobilization by halo-vest device and had nonunion of fracture 8 weeks after the treatment. All operated patients had a solid fusion.

If closed reduction of the odontoid fracture with a significant displacement was achieved then external immobilization by halo-vest device can be used. Posterior fusion is the treatment of choice for irreducible odontoid fractures.