title: Traumatic (type II) odontoid fracture with transverse atlantal ligament injury: a controversial event.
abstract: OBJECTIVE
  Traumatic (Type II) odontoid fractures are very common injuries. Nevertheless, their connection with transverse atlantal ligament injury is controversial and poorly defined. The aim of this study is to report a single case of traumatic (type II) odontoid fracture with transverse atlantal ligament injury and to critically analyze the role of ligaments and membranes together with neuroradiological tools in the management of craniovertebral junction-traumatized patients.
  
  
  METHODS
  We report 27 consecutive cases of traumatic (type II) odontoid fractures who underwent magnetic resonance imaging (MRI) in the acute phase injury (<72 hours), focusing our attention on the transverse atlantal ligament.
  
  
  RESULTS
  One patient (3.7%) demonstrated a transverse atlantal ligament injury on MRI. The patient underwent surgery.
  
  
  CONCLUSIONS
  Traumatic (type II) odontoid fracture with transverse atlantal ligament avulsion can be considered an unusual event. It is our opinion that the routine use of MRI for all patients with type II odontoid fracture could be unjustified in clinical practice. Strict clinical surveillance of all patients managed conservatively and the use of MRI in selected cases could be a reasonable management option.
authors.affiliation: Department of Neurosurgery, Niguarda Cà Granda Hospital, Milan, Italy. albertodebernardi@hotmail.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Debernardi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Aliberti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Talamonti
authors.forename: Fabio
authors.initials: F
authors.lastname: Villa
authors.forename: Maurizio
authors.initials: M
authors.lastname: Piparo
authors.forename: Marco
authors.initials: M
authors.lastname: Cenzato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008023:Ligaments, Articular / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009809:Odontoid Process / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D012680:Sensitivity and Specificity; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000601:surgery; D016103:Spinal Fractures / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D055815:Young Adult