Management of the fractured odontoid with halo-thoracic bracing

This study of 65 cases of fractured odontoid indicates that halo-thoracic bracing is an effective method for treatment of the Types II and III fractures. There were 28 Type II, and 19 Type III fractures treated with halo-thoracic braces. Of these 47 patients, only 4 went on to nonunion after an average of 8 weeks in the brace, a rate of bony union of 91.5%. Seven of the remaining 18 patients underwent primary fusion at C1-2, two were treated in Guilford braces, and six received no treatment. Surgery was performed if the fracture was unstable, if the patient could not be relied upon to leave the halo in place, or if the patient chose it as primary treatment. All seven of these patients went on to bony fusion. All of the six patients who refused treatment went on to nonunion of the fracture. Three patients were lost to follow-up.