Type 2 odontoid fracture unstable,m&p 9 performance parts,diabetes and weight loss studies,medication errors by nurses essay schrijven - Downloads 2016

The classification of Anderson and D’Alonso (Figure 3), proposed in 1970 is the most accepted and widespread. The type II fractures occur between the transverse ligament and the body of the axis, without extension to the articular facets of C2. Conservative treatment can be done by external immobilization with a rigid cervical-thoracic orthosis , plaster-type minerva or halo vest. In order to guide the indication of this technique, Grauer and colleagues divided the type II fractures into 3 subtypes according to fracture line. Besides the fracture, it is important to consider the clinical condition of the patient to decide the most appropriate type of treatment. With the conservative treatment, the pseudarthrosis risk varies from 26 to 80% in the literature. In patients with favorable fracture line and intact transverse ligament, osteosynthesis  with interfragmentary screw can be used.  (Figura4b). MRI shows also injury of the myelon.Control CT scan after installation of a halo vest shows even further dislocation of the dens.

Occur in a region of poor vascularization and are associated with an increased risk of pseudarthrosis. The type IIB fracture corresponds to a a fracture line that runs from antero-inferior to posterior-superior, or a transverse fracture.
In the younger population, the odontoid fracture is the result of higher energy trauma such as auto accidents. However, it also may be present in cranio-cervical dislocation, which are highly unstable lesions.
Risk factors for pseudoarthrosis are initial deviation greater than 4-6 mm, angulation greater than 10 °, and age at diagnosis above 65. Patients with significant risk factors for nonunion can be treated more safely in a surgical fashion. The type IIC  corresponds to a fracture line running from anteroinferior to posterosuperior or there is significant comminution. Hadley and colleagues have proposed the inclusion of subtype IIa in the classification of Anderson D’Alonso.

This subtype refers to a fracture that has a anterior or posterior comminution (5% of cases). In chronic lesions, dynamic radiographs can be used to evaluate the mobility of the fragments. This pattern of fracture is associated with an increased risk of pseudoarthrosis and therefore  surgical treatment is recommended. The reconstructions in the sagittal (Figure 12) and coronal planes helps to choose  treatment  and surgical technique.

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