Odontoid screw fixation preserves atlanto axial rotations, however, this approach is contraindicated in certain fracture orientation and angulation where inter fragmentary compression cannot be achieved. Each of these techniques has its own advantages and limitations, however, patient tailored treatment remains the most prominent method for management of these fractures. As of now, the surgical treatment options include C1-C2 arthrodesis and anterior screw fixation of C2 and occipitocervical fusion. Successful nonsurgical management of type II fractures with halo thoracic vest (HTV) has been reported, however, it is associated with poor patient tolerance and high non-union rate. The question how to successfully stabilize type II odontoid fractures still remains unanswered. Generally, nonsurgical bracing is the mainstay of management to stable type I and III odontoid fractures and has demonstrated high healing rates. Odontoid fractures have been anatomically classified in three types by Anderson and D'Alonzo based on the position of the fracture line. The incidence of associated atlas and axis fractures is 12% and in the majority of these cases, the odontoid fracture determines the management strategy. The most frequent association of type II odontoid fractures is atlas fractures. In young patients, these fractures are usually secondary to high energy trauma, with motor vehicle accidents being responsible for the majority of odontoid injuries. Odontoid fractures are generally rare and account for approximately 15% of all cervical fractures.
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