The high levels of morbidity and mortality associated with odontoid fractures should encourage all providers to pursue medical co-management and optimization of bone health following diagnosis. If operative management is chosen, a posterior approach is should be chosen when fracture- or patient-related factors make an anterior approach challenging. In a frail elderly patient, a fibrous nonunion with close follow-up is an acceptable outcome. However, the risks of surgery in an elderly population must be carefully considered on a case-by-case basis. Type II fractures with any additonal risk factors for nonunion (displacement, comminution, etc) should be considered for surgical management. We believe that type I and type III odontoid fractures can be managed in a collar in most cases. A treatment algorithm is presented based on the available literature. The merits of operative vs nonoperative management, fibrous union, and the choice of operative approach in elderly patients are discussed. However in the recent literature there seems to be a tendency to opt for primary internal fixation with interfragmentary screws 1, 7, 8, 19, 23, 29, 36.The reported rate of non-union varies between 2. We provide a review of the existing literature and discuss the classification and evaluation of odontoid fractures. The appropriate treatment of type II and III odontoid fractures still remains controversial. Poor bone health and medical comorbidities contribute to increased surgical risk in this population however, nonoperative management is associated with a risk of nonunion or fibrous union. The joint between C2 and the vertebra above, C1, has an outstanding range of motion. The bone involved in odontoid fracture is the second vertebra, C2, high up in the neck. Despite their frequency, there is considerable ambiguity regarding optimal management strategies for these fractures in the elderly. A type II odontoid fracture is a break that occurs through a specific part of C2, the second bone in the neck. However, since he was having pain and was neurologically intact, he was offered nonoperative management consisting of a hard cervical collar. There was initial concern whether the fracture is acute or chronic. Odontoid fractures are the most common fracture of the axis and the most common cervical spine fracture in patients over 65. Cervical spine CT demonstrated DISH from C2 to T2 and a minimally displaced type 2 odontoid fracture (Figure 1).
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