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Odontoid fractures following blunt trauma often involve certain spinal and sometimes non-spinal damage

Victims of forceful blunt trauma to the neck often suffer from a certain type of spinal injury, odontoid fractures. These fractures often produce instability of the cervical spine. In fact, patients often have other spine injuries and frequently suffer non-spine-related injuries and neurologic impairment, concludes the largest study ever done on patients with blunt trauma to the neck.

Knowing this may help doctors identify and manage patients with odontoid fractures, note William R. Mower, M.D., Ph.D., and colleagues at the University of California, Los Angeles School of Medicine. As part of the National X-Radiography Utilization Study (NEXUS)—the most definitive study to date of this type of odontoid injury—they prospectively studied x-rays of the cervical spine and any ancillary studies for 34,069 blunt trauma patients evaluated at 21 emergency departments (EDs) across the United States. This research was supported by the Agency for Healthcare Research and Quality (HS08239).

Dr. Mower and colleagues found that 2.4 percent (818) of these blunt trauma victims sustained a cervical spine injury, with slightly more than 10 percent of these victims (94) sustaining a fracture of the odontoid. The rate of odontoid fractures varied by age, from less than 3 percent among those under age 20 years to greater than 20 percent in patients over 80 years of age. Over half of the odontoid fracture victims sustained additional cervical spine injuries, with 90 percent of these injuries involving the atlanto-axial complex. Also, 52 percent suffered from non-spine-related injuries, over one-third (34 percent) arrived at the ED with an altered level of alertness, and almost one-fourth (23 percent) exhibited some form of focal neurologic deficit associated with their injury.

Odontoid cervical spine injuries are important to detect because immediate treatment and long-term prognosis depend on accurate diagnosis of the injury. Odontoid fractures that are mechanically stable tend to heal with conservative treatment, while those that involve fractures of the vertebral body may require prolonged immobilization or surgery. The authors suggest that radiologists be cognizant of the high prevalence of odontoid fractures in victims of blunt trauma to the neck and focus careful attention on the region of the atlanto-axial complex.

See "Odontoid fractures following blunt trauma," by Dr. Mower, Jerome R. Hoffman, M.D., and Michael I. Zucker, M.D., Emergency Radiology 7, pp. 3-6, 2000.

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