Extract
Dens fractures have accounted for 7% to 17% of all fractures of the
cervical spine in series of up to 625 cervical
fractures1-5.
In the classification system of Anderson and D'Alonzo, a type-III dens
fracture extends downward into the cancellous portion of the body of the
axis6 and typically
heals without surgical intervention. After adequate reduction with traction,
the use of a halo vest or halo cast has been associated with union rates of
80% to 100% in series ranging from twenty-one to 107
fractures1,4,5.
Although displacement and/or
dislocation2 of a
dens fracture has been described in terms of translation or angulation,
vertical displacement as a factor in determining stability or the adequacy of
reduction has received little attention. Two case reports described vertical
displacement of a type-III odontoid
fracture7,8.
Neurologic injury followed routine application of traction in both patients.
The first patient became a ventilator-dependent quadriplegic, and the second
died of complications from paralysis. The authors recommended aggressive
surgical management when faced with this fracture pattern.