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Case of the Week 248



What's the most likely diagnosis?

  • 38 year-old in a motor vehicle accident

  1. Jefferson Fracture
  2. Hangman's Fracture
  3. Fracture of the Dens
  4. Burst Fracture
  5. Clay Shoveler's Fracture


Answer:

 


3. Fracture of the Dens

 

 

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Fracture of the Dens

General considerations

  • Most dens fractures are caused by motor vehicle accidents and falls
  • About 1/3 of C-spine injuries occur at C2 and about ½ at C6-C7
  • As expected, most fatal cervical spine injuries occur at C1 or C2
  • Most odontoid fractures occur with flexion, extension and rotation

Normal anatomy

  • Odontoid process (dens) of C2 (atlas) articulates with C1 (axis) with three joints
    • Central atlantoaxial joint
    • Bilateral. Lateral atlantoaxial joints
  • Ligaments (transverse and dentate) provide rotational and translational stability
    • Transverse ligament holds dens in close approximation to anterior arch of C1
  • Dens represents the fused remnants of the body of C1

 

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