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NewYork-Presbyterian Hospital Psychiatry
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Case of the Month 12/05

The NewYork-Presbyterian Emergency Department radiology teaching files database has been built up over the last several years. All cases in the database were seen at the NewYork-Presbterian Emergency Department. This case is drawn from the database. Review the image and read the corresponding case before going on to the answers.

This 76-year-old woman was involved in a motor vehicle accident. The patient was a restrained passenger sleeping at the time of the accident, which occurred when her husband, the driver, rear-ended the car in front of them at a speed of roughly 45 to 50 miles per hour. The airbag deployed and she awoke. She denied any history of head trauma or loss of consciousness during the accident. The patient exited the car independently and walked to a nearby patrol car without difficulty. The patient denied any focal neurologic symptoms, including bowel or bladder symptoms.

Q: Name the radiologic abnormality (name the location as well as the classification.)
View answer
A: Type III odontoid fracture.

A type I odontoid fracture involves only the upper part of the odontoid process.
A type II odontoid fracture occurs where the odontoid process and the body of the second cervical vertebra join.
A type III odontoid fracutre is through the upper body of the second cervical vertebra.

Canale: Campbell's Operative Orthopaedics, 10th ed., Copyright © 2003 Mosby, Inc.

Q: How do you treat this problem?
View answer
A: Some odontoid fractures can be treated with external support (such as C collar or halo traction) alone while others (especially type II) require operative management.
Q: Which type of odontoid fracture is most common?
View answer
A: Type II odontoid fractures occur much more commonly than type I or III.

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