0:01

We talked initially about the craniovertebral junction fractures,

0:05

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

0:09

the C1 and C2 fractures.

0:11

This is an interesting case because

0:13

it has both. On the axial scan,

0:16

as we go from the intracranial compartment

0:19

down to the cervical spine,

0:21

we notice that there is a fracture

0:23

of the anterior arch of C1

0:25

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

0:30

so a little bit of area here where there

0:32

may be an injury, as well.

0:35

However,

0:36

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

0:40

there is a fracture which also extends into

0:43

the upper vertebral body of C2.

0:47

The alignment doesn't look bad,

0:48

and when we look at the soft tissue windows,

0:51

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

0:55

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

0:59

These fractures are very well demonstrated also

1:02

on the sagittal and coronal reconstructions.

1:04

Here's our sagittal reconstruction showing the

1:07

fracture line at the base of the odontoid.

1:10

What we want to see is whether it goes

1:12

into the vertebral body of C2,

1:15

because that distinguishes the type II odontoid

1:19

process from the type III odontoid process.

1:22

And I think that's better demonstrated

1:24

here on the coronal view,

1:26

where you can see that we are actually involving the

1:30

top of the base of the vertebral body of C2.

1:33

So this would be a type III odontoid fracture.

1:37

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

1:43

that's better seen on the axial scans,

1:45

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

1:51

reconstruction and the separation of this anterior

1:54

piece from the transverse process of

1:58

C1 and lateral mass of C1.

2:01

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

2:05

It's got a little bit of hyperdense border,

2:08

so could that be of a congenital nature?

2:12

We want to look and see whether there are prior

2:14

films in order to make that determination.

2:16

Let's look at that C1 fracture on the coronal

2:20

reconstructions. Here we are going posteriorly.

2:23

Definitely looks like a fracture on that right side as opposed

2:27

to a congenital problem. As we come further anteriorly,

2:32

we see the comminuted nature of the fracture on the right

2:36

side at the C1 anterior arch and lateral mass.

2:41

Note that the alignment of the C1 and C2 vertebrae

2:46

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

2:49

And even on the sagittal scan,

2:52

there's no widening of the atlantodental space anteriorly.

2:58

These relationships are very important to evaluate,

3:02

and we will see shortly that there are measurements to be

3:06

made to make sure of the stability of these fractures.

Case 25 - Odontoid Fracture

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