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Fractures of the odontoid process

AN ANGIOGRAPHIC AND CLINICAL STUDY

Department of Orthopaedic Surgery

J. F. Maharaj, FFRAD, Senior Lecturer

Department of Radiology, University of Natal, Private Bag 7, Congella, 4013 Durban, South Africa.

M. R. Haffajee, FRCS, Professor

Department of Anatomy, University of Durban-Westville, Private Bag X54001, 4000 Durban, South Africa.

Correspondence should be sent to Professor S. Govender.

We treated 183 patients with fractures of the odontoid process (109 type II, 74 type III) non-operatively. Union was achieved in 59 (54%) with type-II fractures. All type-III fractures united, but in 16 patients union was delayed. There was no correlation between union and the clinical or radiological outcome of the fractures. Selective vertebral angiography, carried out in 18 patients ten with acute fractures and eight with nonunion, showed that the blood supply to the odontoid process was not disrupted. Studies on ten adult axis vertebrae at post-mortem showed that the difference in the surface area between type-II and type-III fractures was statistically significant. Our findings show that an age of more than 40 years, anterior displacement of more than 4 mm, posterior displacement and late presentation contribute towards nonunion of type-II fractures.