From the Guidelines
Surgical intervention is the preferred treatment option for odontoid fracture type II, especially in cases with significant displacement or angulation, due to its ability to provide immediate stability and reduce the risk of nonunion and spinal cord injury. Treatment options for type II odontoid fractures include both conservative and surgical approaches [(1] is not relevant to this specific question as it pertains to heel pain). Conservative management typically involves external immobilization with a rigid cervical collar or halo vest for 8-12 weeks. However, surgical intervention is often recommended for patients with fracture displacement greater than 5mm, angulation exceeding 10 degrees, or in elderly patients who have higher nonunion rates with conservative treatment.
Key Considerations
- Fracture characteristics such as displacement, angulation, and comminution play a crucial role in determining the treatment approach.
- Patient factors including age and comorbidities also influence the choice between conservative and surgical management.
- Surgical options include anterior odontoid screw fixation, which preserves C1-C2 motion but requires specific fracture patterns for success, or posterior C1-C2 fusion techniques such as transarticular screw fixation or C1 lateral mass-C2 pedicle screw constructs.
Postoperative Care
- Appropriate pain control with NSAIDs or short-term opioids is essential for patient comfort.
- Gradual mobilization and regular radiographic follow-up to assess healing are critical components of postoperative management.
- Early intervention is crucial as these fractures can lead to spinal cord injury if left untreated or if treatment fails.
From the Research
Treatment Options for Odontoid Fracture Type II
The treatment options for odontoid fracture type II include:
- Conservative management with immobilization in a cervical collar or halo vest 2
- Surgical management with anterior odontoid screw fixation (AOSF) or posterior cervical instrumented fusion (PCIF) 3, 4, 5
- Nonoperative management with a Philadelphia collar or similar orthoses 2
Surgical Treatment
Surgical treatment is recommended for patients older than 50 years with type II odontoid fractures, as well as in patients at a high risk for nonunion 4. The choice of surgical approach depends on various factors, including:
- Fracture anatomy and direction of fracture line 3
- Patient age and comorbidities 4, 5
- Presence of neurological deficit or associated unstable subaxial spine injury 5
Conservative Management
Conservative management is also a viable option, especially in elderly patients with minimal displacement and no neurological deficit 2, 6. A study found that a conservative approach to odontoid type II fracture in elderly patients resulted in an excellent functional outcome in the majority of cases, regardless of bony fusion 6.
Comparison of Treatment Options
A comparison of treatment options found that AOSF can preserve atlantoaxial motion, but requires a reduced odontoid and an intact transverse ligament 4. PCIF, on the other hand, has a higher rate of fusion and is indicated in patients with severe atlantoaxial misalignment and poor bone quality 4. The choice of treatment ultimately depends on the individual patient's characteristics and fracture anatomy.