Abstract
Fractures of the odontoid process seem to have an unclear and not well-understood behavior. This is well demonstrated in the literature as there is a disagreement in many fields, including the patterns of fractures, the percentage of pseudarthrosis or the appropriate treatment that is required. This situation makes the fracture itself a “challenging” one. Indeed, despite the existence of extensive literature, there are still many unresolved problems concerning these fractures. We recognize six main classification schemes of the odontoid process fractures which clearly demonstrate the presence of differences but, also, the disadvantages that these classifications are related to. The most important factors that render these fractures “enigmatic” are the anatomy of the odontoid, the diversity of fractures encountered, the radiological evaluation, the stability and the inability to incorporate the whole spectrum of fractures in one classification. The progress made the last decades in the field of the radiology and their follow-up permitted to better analyze these lesions and to extract useful conclusions.
Similar content being viewed by others
References
Korres DS (2013) Fractures of the odontoid process. In: Korres DS (ed) The axis vertebra, chap. 6. Springer, Rome, pp 45–59
Korres DS, Karachalios Th et al (2004) The structural properties of the axis studied in cadaveric specimens. Clin Orthop Relat Res 418:134–140
Gadaifis N (2014) Study of the periosteum and its vascularity as a possible factor for the incidence of pseudarthrosis in different types of fracture of the odontoid process of the axis vertebra. Dissertation. Medical School, University of Athens (in Greek)
Roy-Camille R, Lepresie PH, Mazel C (1986) Les fractures del’ odontoid. In: Roy-Camille (ed) Rachis cervical supérieur Masson Cie Paris. Masson, Paris, pp 99–118
Korres DS, Lazaretos J, Papailiou Kyriakopoulos E, Chytas D, Efstathopoulos NE, Nikolaou VS (2015) Morphometric analysis of the odontoid process: using computed tomography—in the Greek population. Eur J Orthop Surg Traumatol 26(2):119–125
Gebauer M, Lohse C, Barvencik F, Pogoda P, Rueger JM, Püschel K, Amling M (2006) Subdental synchondrosis and anatomy of the axis in aging: a histomorphometric study on 30 autopsy cases. Eur Spine J 15(3):292–298
Gebauer M, Amling M (2008) The development of the axis vertebra: the key to a topographic classification of dens fractures. Eur Spine J 17Q:1775–1778
Wang XP, Deng ZC, Liang ZI, Tu YM (2008) Response to reply to the letter to the editor concerning “Gebauer et al subdentale sychondrosie and anatomy of the axis in the aging: a histomorphometric study on 30 autopsy cases”. Eur Spine J 15:292–298, the base of the dens axis. Where is it located? Eur Spine J 17:1771–1774
O’Brien WT, Shen P, Lee P (2015) The dens: normal development, developmental variants and anomalies, and traumatic injuries. J Clin Imaging Sci 2015(5):38
Roy-Camille R, Saillant G, Judet Th, De Bollon G, Michel C (1980) Elements de pronostic des fractures de l’ odontoide. Rev Chir Orthop 66:183–186
Schatzker J et al (1971) Fractures of the dens (odontoid process): an analysis of thirty-seven cases. J Bone Joint Surg Br 53:392–405
Anderson LD, D’Alonzo R (1974) Fractures of the odontoid process of the axis. J Bone Joint Surg Am 56:1663–1674
Althoff B, Bardholm H (1979) Fractures of the odontoid process. An experimental and clinical study. Acta Orthop Scan Suppl 177:1–91
De Mourgues G, Fischer LP, Bejui J, Carret JP, Gonon GP, Subasi H, Amoa J, Herzberg G, Massardier J (1981) Fractures of the odontoid process. Rev Chir Orthop Repara Appar Mot 67:783–790 (in French)
Roy-Camille R, De La Caffiniere JH, Saillant G (1973) Traumatisme du rachis cervical supérieur C1–C2. Masson, Paris, pp 51–55
Korres DS, Mavrogenis AF, Gratsias P, Lyritis GP, Papagelopoulos PJ (2008) It is time to reconsider the classification of dens fractures. Eur J Orthop Surg Traumatol 18:189–195
Bergenheim T, Forssel A (1991) Vertical odontoid fracture-case report. J Neurosurg 74:665–667
Korres DS, Mavrogenis AF, Gratsias P, Posantzis MP, Giannakopoulos EA, Efstathopoulos NE (2010) Type D fractures of the odontoid process. Eur J Orthop Surg Traumatol 20:597–601
Korres DS, Stamos KG, Andreakos AG, Chr Hardouvelis, Kouris A (1989) Fractures of the dens and risk of pseudarthrosis. Arch Orhop Trauma Surg 2:373–376
Benzel E, Hart BL et al (1994) Fractures of the C2 vertebral body. J Neurosurg 81:206–212
Hadley MN, Brown CM et al (1988) New subtype of acute odontoid fractures (type IIA). Neurosurgery 22:67–71
Gauer JN, Shaft B et al (2005) Proposal of a modified, treatment-oriented classification of odontoid fractures. Spine J 5:123–129
Reihold M, Bellabarba C et al (2011) Radiographic analysis of type II odontoid fractures in a geriatric patient population: description and pathomechanism of the “Geier”–deformity. Eur Spine J 20:1928–1939
Jea A, Tatsui C, Hamad F, Vanni S, Levi A (2006) Vertically unstable type III odontoid fractures: case report. Neurosurgery 58(4):E797
Adam D, Cergan R, Iftimie D, Moisescu C (2016) Odontoid fracture that is not listed in the existing classifications A new subtype of odontoid fracture: case report. Rom Neurosurg XXX(1):57–64
Koller H, Kammermeier V et al (2006) Spinal stenosis C1–C2 following redo surgery for failed odontoid screw fixation-scrutinizing the odontoid fracture classification. Internet J Spine Surg 3:1–11
Marra MA (2013) Study of dens fracture in the elderly and the role of osteoporosis with a finite element model. Master of Science Thesis in Medical Engineering. Stockholm, 2013
Denaro V, Papalia R, Di Martino A, Denaro L, Maffulli N (2011) The best surgical treatment for type II fractures of the dens is still controversial. Clin Orthop Relat Res 469(3):742–750
Falavigna A (2016) Management of type II odontoid process fracture in octogenarians (editorial). J Neurosurg Spine 19:1–2
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that there is no conflict of interest related to this publication.
Rights and permissions
About this article
Cite this article
Korres, D.S., Chytas, D.G., Markatos, K.N. et al. The “challenging” fractures of the odontoid process: a review of the classification schemes. Eur J Orthop Surg Traumatol 27, 469–475 (2017). https://doi.org/10.1007/s00590-016-1895-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-016-1895-3