Type III fractures are treated with halo immobilization, odontoid screw fixation, or C1-C2 arthrodesis. Deep, displaced, or angulated fractures are treated with closed reduction and halo thoracic immobilization. Uncomplicated shallow type III fractures are treated with odontoid screw fixation. Nonunion and malunion are potential complications. The vertical type of odontoid process fractures is addressed in the treatment section on traumatic spondylolisthesis.
A prospective, controlled study (N=42) evaluated the safety and efficacy of percutaneous anterior screw fixation versus open screw fixation for type II and rostral type III odontoid fractures. [20] Clinical and radiographic resultsshowed significantly less operating time and less blood loss in the percutaneous anterior screw fixation group. Both groups experienced satisfactory bony union, similar radiation time, and clinical outcome, and no evidence of abnormal movement at the fracture site was noted. These data suggest that percutaneous anterior screw fixation may be a safe and reliable alternative with potential advantages for treatment of type II and rostral type III odontoid fractures.
Another study evaluated the outcomes after anterior screw fixation of type II and rostral shallow type III fractures. The study found that the risk of fusion failure was 37.5 times greater in patients in whom surgery was delayed for more than 1 week and 21 times greater in patients with a fracture gap of greater than 2 mm. [21]
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Odontoid type II fracture
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Atlantooccipital and atlantoaxial dissociation
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Hangman fracture
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Three types of C2 odontoid fractures: type I is an oblique fracture through the upper part of the odontoid process; type II is a fracture occurring at the base of the odontoid as it attaches to the body of C2; type III occurs when the fracture line extends through the body of the axis.
