• HPI: An unhelmeted, 63 year old female fell face first off of her bike while attempting to avoid a car. She reports no loss of consciousness. She was ambulatory at the scene and was taken to the emergency department by family. She complains of neck and periorbital pain. She has been a 2 pack-per-day smoker since the age of 18. 

    Past Medical History: GERD, sleep apnea 

    Past Surgical History: None 

    Neurologic: 
    Alert and oriented X 3 
    No cranial nerve abnormality 
    Posterior neck tender to palpation 
    Sensation intact to light touch and pin prick 
    Strength 5/5 in all muscle groups bilaterally 
    Deep tendon reflexes normal 
    No pathologic reflexes

    Figure 1. Sagittal and coronal reconstruction of CT-Scan demonstrates a C2 fracture.

    1. How would you classify this odontoid fracture?

    2. Of the following, which factor in this case would deter you most from performing an odontoid screw for fixation?

    3. Do you recommend hard cervical collar for patients that have been treated with odontoid screw fixation?

    4. How do you follow up patients that have undergone odontoid screw fixation?

    5. Which of the following describes you?

    6. I practice in one of the following locations.

    7. Please add any suggestions or comments regarding this case:

    • I would also consider a posterior fusion of C1-C2.
    • looks to be in good alignment. would treat in a collar first
    • The MR images could not be shown and if transvere ligaments may be injured, odontoid screw fixation could not be performed. But the surgeons have to decide management of the odontoid fractures depending on their practice and skills.
    • Good exercise!
    • nice case
    • Great case!
    • The patient appears to have an auto-fusion of C1-C2. If she fails to heal in a collar she should have a posterior C1-C2 fusion.
    • Very intresting case.Now I have a patient with odontoid fracture type III and disruptión of ligament.
    • where is MRI of this case to complete evaluation
    • comments
    • Why are a hard collar and C1-C2 fusion only not listed as options, given the available information. Please respond to rockumar@verizon.net. Thanks

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