title: Closed management of displaced Type II odontoid fractures: more frequent respiratory compromise with posteriorly displaced fractures.
abstract: OBJECTIVE
  Acute respiratory failure has been observed in patients after external immobilization for displaced odontoid fractures. The authors studied the frequency of respiratory deterioration in the acute management of displaced Type II odontoid fractures to identify patients at risk for respiratory failure.
  
  
  METHODS
  The authors conducted a retrospective review of a consecutive series of 89 patients with odontoid fractures who were treated over a 5-year period to identify 53 patients with displaced Type II odontoid fractures. Patient demographics, degree of displacement, respiratory status, treatment method, and outcome were examined. Of the 32 patients with posteriorly displaced fractures, 13 experienced acute respiratory compromise, whereas only one of 21 patients with anteriorly displaced fractures had respiratory difficulties (p = 0.0032). The average posterior displacement was 6.9 mm. All 13 were initially managed using flexion traction for reduction of these fractures. Two of these patients died because of failure to emergently secure an airway during closed treatment of the fracture.
  
  
  CONCLUSIONS
  Frequent respiratory deterioration during acute closed reduction of posteriorly displaced Type II odontoid fractures was observed, whereas respiratory failure in patients with anteriorly displaced fractures was rare. The use of the flexed cervical position in the setting of retropharyngeal edema rather than the direction of the displacement may substantially increase the risk of respiratory failure. This may prompt early elective nasotracheal intubation during closed reduction of posteriorly displaced Type II odontoid fractures that require a flexed posture.
authors.affiliation: Department of Neurosurgery, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. gregory.przybylski@mail.tju.edu
authors.forename: G J
authors.initials: GJ
authors.lastname: Przybylski
authors.forename: J S
authors.initials: JS
authors.lastname: Harrop
authors.forename: A R
authors.initials: AR
authors.lastname: Vaccaro
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D009809:Odontoid Process / Q000293:injuries / Q000503:physiopathology / Q000601:surgery; D009984:Orthopedic Fixation Devices; D012131:Respiratory Insufficiency / Q000209:etiology*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000150:complications* / Q000601:surgery*