How are type II C2 fractures treated?

Updated: Nov 21, 2018
  • Author: Igor Boyarsky, DO, FACEP, FAAEM; Chief Editor: Jeffrey A Goldstein, MD  more...
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Answer

Type II fractures can be managed conservatively or surgically. Treatment options include the following:

  • Halo immobilization
  • Internal fixation (odontoid screw fixation) [11]
  • Posterior atlantoaxial arthrodesis

Arthrodesis can be accomplished by C1-C2 transarticular screw fixation, interlaminar clamps, or wiring techniques such as the Gallie or the Brooks method. [12, 13, 2, 14]

Management with the halo vest usually is considered if the initial dens displacement is less than 5 mm, the reduction is performed within 1 week of the injury and is able to be maintained, and the patient is younger than 60 years. During immobilization, alignment is assessed to ensure that reduction is maintained. Displacement of less than 20% is acceptable. The halo vest is in place for 12-16 weeks and the fusion rate is over 90%. [15]

Wiring techniques, such as Gallie or Brooks methods, offer a high fusion rate (~95%); however, the posterior arch needs to be intact and a halo vest must be worn postoperatively. Transarticular screw fixation provides a high fusion rate and the posterior arch need not be intact. Although posterior surgical fusion techniques provide high fusion success rates, they do so at the expense of cervical rotation. Generally, up to 50% of rotation is lost with these techniques.


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