Odontoid fractures: update on management

J Am Acad Orthop Surg. 2010 Jul;18(7):383-94. doi: 10.5435/00124635-201007000-00001.


Recognition of the incidence of odontoid fractures as well as the associated morbidity and unexpectedly high mortality rates has prompted significant changes in the management of these fractures in the past decade. Nonsurgical management of type II odontoid fracture has historically been associated with a high nonunion rate. Thus, new classification systems have been devised to identify patients who might benefit from early surgical treatment. The decision-making process is particularly difficult when treating elderly patients. Increased familiarity with anterior and posterior surgical techniques has led to more aggressive treatment of odontoid fracture, with the intent of hastening functional rehabilitation. However, these clinical decisions have been associated with a significant rate of complications. The treatment algorithm for odontoid fractures continues to evolve based on the improved understanding of, and evidence-based literature on, anterior screw fixation, posterior spinal fusion, and halo-vest immobilization.

Publication types

  • Review

MeSH terms

  • Arthrodesis
  • Atlanto-Axial Joint / injuries*
  • Fracture Healing
  • Fractures, Ununited / epidemiology
  • Humans
  • Laminectomy
  • Odontoid Process / diagnostic imaging
  • Odontoid Process / injuries*
  • Orthotic Devices
  • Risk Factors
  • Spinal Fractures / classification
  • Spinal Fractures / diagnostic imaging
  • Spinal Fractures / surgery
  • Spinal Fractures / therapy*
  • Tomography, X-Ray Computed
  • Treatment Outcome