Odontoid screw fixation for fresh and remote fractures

Fractures of the odontoid process are common, accounting for 10% to 20% of all cervical spine fractures. Odontoid process fractures are classified into three types depending on the location of the fracture line. Various treatment options are available for each of these fracture types and include application of a cervical orthosis, direct anterior screw fixation, and posterior cervical fusion. If a patient requires surgical treatment of an odontoid process fracture, the timing of treatment may affect fusion rates, particularly if direct anterior odontoid screw fixation is selected as the treatment method. For example, type II odontoid fractures treated within the first 6 months of injury with direct anterior odontoid screw fixation have an 88% fusion rate, whereas fractures treated after 18 months have only a 25% fusion rate. In this review, we discuss the etiology, biomechanics, diagnosis, and treatment (including factors affecting fusion such as timing and fracture orientation) options available for odontoid process fractures.