title: Odontoid fracture biomechanics.
abstract: METHODS
  In vitro biomechanical study.
  
  
  OBJECTIVE
  To investigate mechanisms of odontoid fracture.
  
  
  BACKGROUND
  Odontoid fractures in younger adults occur most often due to high-energy trauma including motor vehicle crashes and in older adults due to fall from standing height.
  
  
  METHODS
  Horizontally aligned head impacts into a padded barrier were simulated using a human upper cervical spine specimen (occiput through C3) mounted to a surrogate torso mass on a sled and carrying a surrogate head. We divided 13 specimens into 3 groups on the basis of head impact location: upper forehead in the midline, upper lateral side of the forehead, and upper lateral side of the head. Post-impact fluoroscopy and anatomical dissection documented the injuries. Time-history biomechanical responses were determined.
  
  
  RESULTS
  Four of the 5 specimens subjected to impact to the upper forehead in the midline sustained type II or high type III odontoid fractures due to abrupt deceleration of the head and continued forward torso momentum. Average peak force reached 1787.1 N at the neck at 50.3 milliseconds. Subsequently, the motion peaks occurred for the head relative to C3 reaching 15.2° for extension, 2.1 cm for upward translation, and 5.3 cm for horizontal compression, between 62 and 68 milliseconds.
  
  
  CONCLUSIONS
  We identified impact to the upper forehead in the midline as a mechanism that produced odontoid fracture and associated atlas and ligamentous injuries similar to those observed in real-life trauma. We were not able to create odontoid fractures during impacts to the upper lateral side of the forehead or upper lateral side of the head. Dynamic odontoid fracture was caused by rapid deceleration of the head, which transferred load inferiorly combined with continued torso momentum, which caused spinal compression and anterior shear force and forward displacement of the axis relative to the atlas.
authors.affiliation: From the Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Ivancic
mesh_terms: D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002102:Cadaver; D002574:Cervical Vertebrae; D006259:Craniocerebral Trauma / Q000150:complications; D003654:Deceleration / Q000009:adverse effects*; D004210:Dissection; D005260:Female; D005471:Fluoroscopy; D005546:Forehead; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000209:etiology*; D006257:Head; D006801:Humans; D008297:Male; D009038:Motion; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000293:injuries*; D060726:Torso