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C2 Dens Fx

Last modified by Hussein Abdallah on 2025/05/26 03:17

 

 

FACTS

C2 Axis fracture Types

1. Odontoid/Dens (15% of all C-spine fractures)

2. Hangman's (traumatic spondylolisthesis)

3. Miscellaneous Fx

CONSULT

HPI 

  •  

FOCUSED EXAM

 

IMG 

MRI C-spine with STIR sequences in coronal and axial planes

  • evaluate integrity of transverse ligament. If transverse ligament violated, C1/C2 translation can happen hence cannot do odontoid screw fixation (need C1-C2 fusion)

A/P

- Factors predicting non-union: 

  1. comminution of dens
  2. displacement ≥ 5 mm
  3. > 40 years old
  4. posteriorly displaced fx 
  5. neuro deficits

- Factors necessitating surgical stabilization

  1. displacement ≥ 5mm 
  2. prior nonuinion
  3. instability of fracture in rigid immobilization

Notes

 Type 1Type 2Type 3
stability unstable 
treatment 

rigid immobilization or surgical stabilization / fusion

  • if TAL violated (C1-C2 segment unstable): posterior C1-C2 instrumentation  
  • if TAL not violated: may consider anterior odontoid screw fixation 
 

 

Contents

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Figure 1: Sea