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Case 25 - Odontoid Fracture

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We talked initially about the craniovertebral junction fractures,

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but now I want to talk about the atlas and the axis fractures,

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the C1 and C2 fractures.

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This is an interesting case because

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it has both. On the axial scan,

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as we go from the intracranial compartment

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down to the cervical spine,

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we notice that there is a fracture

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of the anterior arch of C1

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that is comminuted. If we look at the posterior arch of C1,

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so a little bit of area here where there

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may be an injury, as well.

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However,

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we also see that at the base of the odontoid process,

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there is a fracture which also extends into

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the upper vertebral body of C2.

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The alignment doesn't look bad,

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and when we look at the soft tissue windows,

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we can see that the thecal sac is not compromised by the fracture

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nor by the soft tissue swelling just adjacent to the fracture.

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These fractures are very well demonstrated also

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on the sagittal and coronal reconstructions.

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Here's our sagittal reconstruction showing the

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fracture line at the base of the odontoid.

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What we want to see is whether it goes

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into the vertebral body of C2,

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because that distinguishes the type II odontoid

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process from the type III odontoid process.

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And I think that's better demonstrated

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here on the coronal view,

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where you can see that we are actually involving the

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top of the base of the vertebral body of C2.

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So this would be a type III odontoid fracture.

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Now, as far as the fracture involving the C1 anterior arch,

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that's better seen on the axial scans,

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but you do get a sense of pieces of the bone seen on the sagittal

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reconstruction and the separation of this anterior

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piece from the transverse process of

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C1 and lateral mass of C1.

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You get a better sense also of that small fracture posteriorly.

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It's got a little bit of hyperdense border,

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so could that be of a congenital nature?

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We want to look and see whether there are prior

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films in order to make that determination.

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Let's look at that C1 fracture on the coronal

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reconstructions. Here we are going posteriorly.

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Definitely looks like a fracture on that right side as opposed

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to a congenital problem. As we come further anteriorly,

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we see the comminuted nature of the fracture on the right

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side at the C1 anterior arch and lateral mass.

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Note that the alignment of the C1 and C2 vertebrae

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is pretty good here. There's no real offset.

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And even on the sagittal scan,

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there's no widening of the atlantodental space anteriorly.

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These relationships are very important to evaluate,

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and we will see shortly that there are measurements to be

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made to make sure of the stability of these fractures.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Head and Neck

Emergency

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