[Odontoid fracture after high impact trauma : Assess instability correctly]

Area of Science:

• Orthopedics
• Trauma Surgery
• Neurosurgery

Background:

• Odontoid process fractures are common cervical spine injuries, often seen in older adults due to minor trauma.
• In younger individuals, these fractures typically result from high-energy impacts.
• Classification systems, such as Anderson and D'Alonzo, categorize odontoid fractures.

Observation:

• This report details two cases of odontoid fractures (Type III and Type II) associated with traumatic myelopathy.
• Initial computed tomography (CT) scans underestimated the instability in both cases.
• Both patients later exhibited significant instability, leading to fatal spinal cord injuries.

Findings:

• Underestimation of instability in odontoid fractures can occur despite initial CT assessment.
• High-speed trauma warrants consideration for spinal cord injury even with seemingly minor odontoid fractures.
• Cervical myelopathy can be a critical complication, particularly in patients requiring resuscitation without clear medical causes.

Implications:

• Emphasizes the need for heightened clinical suspicion for spinal cord injury in cases of odontoid fractures, especially following high-velocity trauma.
• Recommends liberal use of magnetic resonance imaging (MRI) when CT findings are equivocal or clinical evaluation is compromised (e.g., due to intubation).
• Highlights the importance of early detection and timely treatment of myelopathy to prevent potentially fatal outcomes.