Vertically unstable type III odontoid fractures: case report.
OBJECTIVE
Type III odontoid fractures are generally thought of as unstable fractures that can be successfully treated with an external orthosis. However, there is a rare subtype of Type III odontoid fractures that is similar in the degree of instability to atlanto-occipital dislocation injuries. Not recognizing or not treating this injury urgently and aggressively could lead to devastating iatrogenic neurological injuries such as quadriplegia and fatal lower brainstem palsies.


METHODS
We present the case of a 73-year-old woman with a vertically distracted Type III odontoid fracture and associated quadriparesis and brainstem deficits. The patient was kept in a rigid collar, placed in a kinematic bed, and admitted to the trauma service for the management of her life-threatening systemic injuries. Traction was not applied.


METHODS
As soon as the patient was systemically stable, she was taken to the operating room for C1-C2 fixation with a screw-rod construct supplemented by cable and structural iliac crest bone graft.


CONCLUSIONS
Delayed recognition of this subtype of Type III odontoid fracture could have fatal or highly morbid consequences, such as quadriparesis/-plegia, lower brainstem dysfunction, and ventilator-dependence, for the patient. It is important to keep a high level of suspicion for this unusual subtype of Type III odontoid fracture.
Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
Andrew
A
Jea
Claudio
C
Tatsui
Hamad
H
Farhat
Steve
S
Vanni
Allan D
AD
Levi
D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery