Management of Type II Odontoid Fractures: Experience from Latin American Spine Centers.
OBJECTIVE
To analyze characteristics of type II odontoid fracture (TII-OF), including clinical and radiographic factors, that influence surgical planning in 8 Latin American centers.


METHODS
Retrospective chart review was performed of 88 patients with TII-OF between 2004 and 2015 from 8 Latin American centers. Parameters studied included 1) demographic data and causes of TII-OF, 2) clinical and neurologic presentation, 3) characteristics of fracture (degree of odontoid displacement, displacement of odontoid relative to C2 body, anatomy of fracture line, distance between fragments, presence of comminution, contact area between odontoid and C2 body), 4) type of treatment, and 5) clinical and radiographic outcome. Bone fusion was assessed using computed tomography.


RESULTS
Mean patient age was 45.33 years ± 23.54; 78.4% of patients were male. Surgery was the primary treatment in 65 patients (73.8%), with an anterior approach in 64.6%. Surgery was usually preferred in patients with posterior or horizontal oblique fracture lines, local pain, and a smaller bone contact surface between the odontoid and the body of C2. A posterior approach was chosen when distance between the fractured bone fragments was >2 mm or after failed conservative or anterior odontoid screw treatment in a symptomatic patient.


CONCLUSIONS
The treatment of choice for TII-OF in 8 Latin American trauma centers was surgery through an anterior approach using screw fixation. Posterior segmental C1-C2 fixation was indicated when distance between bone fragments was >2 mm and in symptomatic patients with nonunion.
Neurosurgery Department, Caxias do Sul University Medical School, Caxias do Sul, Brazil. Electronic address: asdrubalmd@gmail.com.
Asdrubal
A
Falavigna
Neurosurgery Department, Caxias do Sul University Medical School, Caxias do Sul, Brazil.
Orlando
O
Righesso
Neurosurgery Department, Caxias do Sul University Medical School, Caxias do Sul, Brazil.
Pedro Guarise
PG
da Silva
National Institute of Orthopedics and Trauma Surgery of Montevideo, Montevideo, Uruguay.
Carlos Rocca
CR
Siri
Division of Neurosurgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
Jefferson W
JW
Daniel
Division of Neurosurgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
José Carlos
JC
Esteves Veiga
National Institute of Traumatology and Orthopedics of Rio de Janeiro, Rio de Janeiro, Brazil.
Gustavo Borges Laurindo
GB
de Azevedo
National Institute of Traumatology and Orthopedics of Rio de Janeiro, Rio de Janeiro, Brazil.
Luis Eduardo
LE
Carelli
Orthopedic Department, Clinica Alemana and University of Chile, Santiago, Chile.
Ratko
R
Yurac
OCA Medical Center in Orthopedics and Trauma Surgery, School of Education, Monterey, Mexico.
Felix Adolfo
FA
Sanchez Chavez
Neurosurgery Department, Cristo Redentor Hospital, Porto Alegre, Brazil.
Ericson
E
Sfreddo
Neurosurgery Department, Cristo Redentor Hospital, Porto Alegre, Brazil.
Andre
A
Cecchini
Neurosurgery Department, Cristo Redentor Hospital, Porto Alegre, Brazil.
Marcelo Martins
MM
do Reis
Tecnológico de Monterrey Campus Guadalajara, Guadalajara, Mexico.
Jose Maria
JM
Jiménez Avila
Department of Orthopedic Surgery, Columbia University, New York, New York, USA.
K Daniel
KD
Riew
D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D001863:Bone Screws; D001915:Braces / Q000706:statistics & numerical data; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000293:injuries*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D013531:Surgicenters / Q000706:statistics & numerical data; D016896:Treatment Outcome
Conservative treatment; Geriatrics; Latin America; Surgical procedures; Type II odontoid fracture