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Odontoid Fractures in Children

This page was last updated on February 20th, 2019

Odontoid fractures usually occur with forceful distension of the cervical spine. They are normally divided into three types:

Type I Odontoid Fracture

  • Fracture above insertion of transverse ligament: This is a fracture of the odontoid process at its rostral end and is usually stable.
  • Must be differentiated from persisting ossification center: This fracture can mimic a persisting ossiculum terminale, a congenital secondary ossification center at the rostral end of the odontoid.
Odontoid Fractrure, Type 1

Type I odontoid fracture: The fracture line is at the level of the transverse ligament. The transverse ligament is rendered incompetent, and thus this is an unstable injury.

Os Odontoideum

Os odontoideum: In contrast to the fracture, the os odontoideum has smooth, well- corticated margins.

Type II Odontoid Fracture

  • Fracture across base of the odontoid process: The location of this fracture is below the transverse ligament, and it is usually unstable.
  • Must be differentiated from persisting os odontoideum: This fracture can be mimicked by os odontoideum, a congenital failure of fusion of the odontoid process to the base. It is also unstable in most cases.
  • Fracture through growth plate: In children, epiphysiolysis may also occur and is usually unstable.
Type II Odontoid Fracture

Type II Odontoid Fracture, coronal and sagittal views: There is a non-displaced fracture through the base of the odontoid.

Type II Odontoid Fracture Screw repair

Odontoid Fracture, Type II Repaired: A compression screw has been placed across the fracture.

Type III Odontoid Fracture

  • Fracture through C2 body: The type 3 fracture is through the vertebral body of C2 below its juncture with the odontoid. It may be stable or unstable depending on amount of body involvement
  • Frequently unstable: If fracture prevents the transverse ligament from applying force to the body of C2 then consider fracture unstable

Epiphysiolysis Injury

  • Epiphysiolysis Injury of the odontoid: This is a fracture of the odontoid that is peculiar to young children. It occurs at the dentocentral synchondrosis.
Epiphysiolysis injury of odontoid

Epiphysiolysis injury in a 22-month-old child after MVA:The injury has occurred through the C2 synchondrosis. The fracture was reduced under fluoroscopy and managed with a halo vest for 2 months. Assessment of healing is difficult because of the radiolucent growth plate. Flexion/extension x-rays are needed to confirm complete healing.


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