Reduction and stabilization of displaced type II odontoid fractures in young adults – A case series of four patients utilizing different operative techniques

Type II odontoid fractures account for over 2/3ds of odontoid fractures, which overall account for approximately 20% of cervical spine fractures. Their specific site at the odontoid base is confounded firstly by instability, and secondly by a poor blood supply, which predisposes these injuries not only to secondary neurological deterioration but importantly to non-union. In young to middle aged patients non-displaced fractures can be managed conservatively with cervical immobilization and serial imaging. Displaced fractures in younger patients comprise a specific subgroup with their own inherent corner-stone surgical considerations. In this group closed fracture reduction and alignment, and a subsequent anterior odontoid screw/s, should be the standard of care where-ever possible. As a second line the posterior C1/C2 Harms stabilisation with subsequent hardware removal, or if not possible a posterior C1/C2 Harms arthrodesis, should be the 2nd and 3rd choices entertained. As a bail out procedure there is still place for the older wiring techniques, such as the modified Gallie fusion augmented by external immobilization or trans-articular screws. We present a case series of four young to middle aged patients who presented to our unit with displaced type II odontoid fractures and underwent different surgical stabilization procedures. Our case series serves to illustrate several of the common surgical considerations encountered by spinal surgeons who manage this problem.