Computed tomography and MRI scans were interpreted independently by two reviewers. Patients without evidence of acute fracture on MRI were considered to have chronic injuries. Magnetic resonance imaging was then examined for evidence of fracture acuity (increased signal in C2 on T2 images). Fractures were classified as chronic or acute based on CT evidence of chronic injury/nonunion including fracture resorption, sclerosis, and cyst formation. Patients aged less than 18 years and those with pathologic fractures were excluded. One hundred thirty-three patients with Type II odontoid fractures presenting to a Level I trauma center.Ĭomputed tomography (CT) and magnetic resonance imaging (MRI) scans, American Spinal Injury Association Motor Score (AMS), and neurologic examination.Īll patients presenting after traumatic injury to a Level I trauma center from May 2005 to May 2010 with a Type II odontoid fracture on CT scan were included. To identify patients presenting with previously unrecognized odontoid fracture nonunions and to document the incidence of new neurologic injury after secondary trauma in this population. We hypothesize that a substantial proportion of odontoid fractures assumed to be acute are actually chronic injuries and have a high rate of late displacement resulting in neurologic injury. Little is known about long-term sequelae of nonoperative management or risk of recurrent injury after nonsurgical treatment. Treatment of Type II odontoid fractures remains controversial, whereas nonoperative treatment is well accepted for isolated Type III odontoid fractures.
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