Odontoid fractures treated with halo-vest

In a consecutive series of 75 patients with unstable cervical spine injuries treated with halo-vest, 1976-1984, a total of 14 patients (comprising 18.7%) had odontoid fractures. Of the patients with odontoid fractures, 1 patient had an incomplete tetraparesis. All patients except 1 were treated within the first day after the trauma. A total of 50% were injured in motor vehicle accidents. The odontoid fracture was reduced by skull traction and then stabilized with a halo-vest for 12 weeks. One patient died within the first 2 weeks after the injury. There were no other serious complications during the treatment. The initial dislocation and reduction was studied. Ten patients were followed-up after 2 years. Another 2 patients died of other causes during that time. One had an Anderson-d'Alonzo Type II fracture that failed to unite. Different prognostic factors were analyzed. Fracture gap and fracture type may have contributed to nonunion. Only 1 patient was totally free from symptoms after 2 years. The halo-vest was well tolerated in all patients and assured a high percentage of healing.