![]() We then describe a technique for performing intraoperative open reduction using newly available long tulip reduction cervical screws and the challenges of obtaining alignment and fusion using a variety of intraoperative maneuvers in the setting of type III odontoid fracture. In this report, we present a case of a patient with a chronic, nondisplaced type III odontoid fracture who sustained a high-force cervical trauma resulting in AA dislocation and traction-irreducible kyphotic rotatory subluxation. 14–17 Alternative strategies are important in situations with destruction of anatomy leading to loss of structures that normally provide rigid instrumented fixation, such as the pedicle or pars of C2. 13 Posterior cervical fixation is an effective treatment for AA instability that can be accomplished by a variety of strategies, including the C1 lateral mass/C2 transpedicular method of Goel and Harms, the transarticular method of Magerl, and the translaminar method of Wright. reviewed 125 patients with type III odontoid fracture and found that conservative management, with cervical collar or halo orthosis, had a 21% failure rate, and most patients in whom the treatment failed displayed progressive anterolisthesis and angulation. Nondisplaced type III odontoid fractures are generally treated nonoperatively but can progress to nonunion and AA instability. 2–9 These injuries can be complex, involving bony, ligamentous, and vascular structures, as well as spinal cord injury. There are only a few published cases of AA dislocation associated with type III odontoid fracture. 1, 2 In one epidemiological review, only 2 of 784 cervical spine fractures were combined AA dislocation and osseus odontoid injury. Type III odontoid fractures in the elderly optimal treatment with a strong recommendation is immobilization in a hard collar.Traumatic atlantoaxial (AA) dislocation in the setting of odontoid fracture is a rare presentation in both adults and children, often caused by high-energy mechanisms associated with significant morbidity and mortality. Type II fractures in this population are recommended to be treated operatively with a weak recommendation, and if treated nonoperatively using a hard collar immobilization device. ![]() Odontoid fractures have a significant morbidity in the elderly (>65 years) population. These abstracts where then reviewed in detail and 117 manuscripts were selected, which were obtained and supplemented with additional manuscripts to form an evidentiary table. The subsequent search resulted in a return of 377 manuscripts. The MEDLINE search engine returned 1759 articles, which were further limited to "all aged (65 and over)," human subjects and the English language. The literature searches revealed low and very low quality evidence with no prospective or randomized studies. These treatment recommendations were then rated as either strong or weak based on the quality of evidence and clinical expertise. Using the GRADE evidence-based review system, the proposed questions were answered using the literature review and expert opinion. ![]() The quality of literature was rated as high, moderate, low, or very low. MeSH keywords were searched through MEDLINE, EMBASE, and the Cochrane Database of Systematic reviews, and pertinent abstracts and manuscripts obtained. However, these articles are of low quality and optimal treatment algorithms do not exist.įocused questions on the treatment of elderly patients with Type II and III odontoid fractures were refined by a panel of spine traumologists surgeons, consisting of fellowship trained neurologic and orthopedic surgeons. Numerous manuscripts have been written about treatment strategies of odontoid fractures in the elderly. To define optimal clinical care for elderly patients with Type II and III odontoid fractures using a systematic review with expert opinion. ![]()
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