Odontoid fracture

Abstract

Case Setting: Primary

Reason for consultation:
Fall from one's own height with frontal blunt injury and mild neck pain

Clinical Hº:

-AP: Hipertension
        Anticoagulated FA
        Dextrocardia
        Chondrocalcinosis
        Osteoporosis
        Dementia

A 97-year-old woman who consulted in a first attention unit due to a fall from her own height with head trauma, frontal injury, nasal trauma and mild neck pain. There is no neurological deficit or loss of consciousness. Given the mechanism of the trauma and the patients symptoms, the possibility of an odontoid
process fracture was raised and the patient was sent to the hospital.
A fracture of the base of the odontoid is not visualized in routine radiographs, only in transoral projection, CT or MRI, hence the importance of diagnostic suspicion.
In addition to the cranial and facial CT scan, a CT scan of the cervical spine confirmed an
odontoid base fracture, class II of the Anderson and DAlonso classification with significant deviation, in addition to a bilateral fracture of the posterior arch and retrolisthesis of C1.

Evolution:
Patient admitted for surgical treatment, but due to the patients age, comorbidities and clinical symptoms, conservative treatment with a cervical collar was decided.

Conclusion:
When faced with an elderly patient, with low-energy trauma with a mechanism of frontal trauma with forced flexion of the neck, the option of fracture of the odontoid process must always be considered in the differential diagnosis.