Natural History of Odontoid Fracture

Cervical spine fractures involving the C2 vertebra, particularly the odontoid, are seen in up to 20% of cases. The majority of axis fractures affect the odontoid. These types of injuries are more prevalent in older adults due to falls from a standing height.

On the other hand, younger adults commonly experience odontoid fractures as a result of high-energy traumas like motor vehicle accidents or falls from significant heights, which often lead to neurological impairments. Additional injuries to the head, face, and lower cervical spine are frequently observed in these cases. In motor vehicle accidents, frontal impact is the primary cause of odontoid fractures.

The classification system developed by Anderson and D’Alonzo in 1974 is commonly utilized to categorize odontoid fractures. It comprises Type I, which refers to an oblique fracture occurring at the upper portion of the odontoid process, Type II, representing a fracture at the junction between the odontoid and vertebral body, and Type III, extending into the C2 body. Recently, Grauer et al. proposed a modified classification scheme aimed at better distinguishing between Type II and III fractures. Additionally, they introduced a more refined classification for Type II fractures based on factors such as fracture orientation, displacement, and comminution.

In 1979, Althoff conducted a thorough biomechanical study on odontoid fractures. The findings revealed that a mix of horizontal shear and vertical compression loading was necessary to consistently generate the three fracture types.

The primary cause of odontoid fractures was identified as sagittal impacts to specific regions of the head. However, due to certain limitations in the study, such as the absence of spinal load and motion measurements, the direct application of the results to clinical settings and the development of injury prevention systems are impeded.

Prior experimental studies have played a significant role in enhancing our understanding of odontoid fractures. For instance, Mouradian et al. successfully induced type II fractures by utilizing a simplified model, while Nightingale et al. observed type III fractures in the majority of their specimens through extension loading.

In another study by Doherty et al., it was demonstrated that type III fractures could be produced by applying posteriorly directed sagittal loads, while type II fractures resulted from a 45° deviation of the force vector from the sagittal plane combined with load application in the posterolateral direction.

Further biomechanical research is necessary to develop an acceleration-driven model that can provide detailed injury data, enabling informed decisions regarding ligamentous instability, reduction techniques, patient positioning, and specific stabilization methods for each fracture type. This research will contribute valuable insights for selecting appropriate treatment options, ranging from conservative approaches to nonconservative interventions.

A study in the literature investigated the mechanisms behind high-energy odontoid fractures. The results indicated that the primary cause of such fractures in 80% of the tested specimens was impact to the upper forehead in the midline. The study utilized a model comprising a cadaveric upper cervical spine specimen positioned between a surrogate head and a surrogate torso mass.

This model enabled the direct transfer of inertial loads to the upper cervical spine. The observations in the study included the occurrence of type II and high type III odontoid fractures. During traumatic events, the average peak loads and accelerations were observed prior to the peak motions, and the head exhibited maximum extension, translation, and compression between 62 and 68 milliseconds.

Motor vehicle crashes are the leading cause of odontoid fractures in younger adults. A clinical study involving 340 patients with axis fracture reported that 71% of the cases were attributed to motor vehicle crashes, followed by falls at 14% and diving at 4%.

Odontoid fracture was the most frequently observed injury, accounting for 58% of the cases. A pioneering study reported by literature, which included 49 patients with odontoid fracture, reported similar rates, with 71% caused by motor vehicle crashes, 20% by falls, and 8% by head impacts.

Another multicenter study reported by literature, involving 144 patients with an odontoid fracture found that 72% of the injuries were sustained in motor vehicle crashes. These findings are consistent with other clinical studies supporting the strong correlation between odontoid fractures and motor vehicle accidents.

As reported in the literature, odontoid fractures in older adults resulting from falls from standing height exhibit similar injury mechanics. Weakened bone, increased loads on the upper cervical spine, and a higher probability of head impact contribute to the higher frequency of these fractures in older individuals.

To validate these findings, future research should involve larger sample sizes and younger specimens. Additionally, exploring the relationship between subaxial cervical spine spondylosis, bone mineral density, and odontoid fractures is recommended. Despite its limitations, the study provides valuable insights into the mechanisms of high-energy odontoid fracture, as documented in the literature

A model described in the literature demonstrated notable strengths by effectively replicating odontoid fractures, ligamentous instability, and associated atlas injuries observed in clinical settings. Unlike previous models, this particular model successfully recreated the dynamic loads and accelerations experienced during real-life traumatic events like motor vehicle crashes, falls, or head impacts.

It accurately simulated the deceleration of the head, leading to load transfer, spinal compression, anterior shear force, and forward displacement of the axis in relation to the atlas. Moreover, the model captured the extensional rotation of the head and its upward translation relative to C3, closely resembling the dynamic responses witnessed in genuine trauma cases..

Attempts to reproduce odontoid fractures through impacts to the upper lateral side of the forehead or head have proven challenging, contrary to findings from previous studies. These studies utilized a model fixed at the C3 vertebra and subjected it to pendulum impacts, resulting in a 37% odontoid fracture rate among the tested specimens, some of which showed substantial ligament injuries or complete separation at the fracture site. In the study, the odontoid fracture rate was slightly lower but comparable at 31% among the specimens.

A specimen in a study reported in the literature displayed distinct head movements during trauma, characterized by significant translation and extension relative to the C3 vertebra. This specimen experienced an early high type III odontoid fracture, estimated to occur between 28 and 45 milliseconds, which aligns with findings from previous research. The fracture disrupted the stability of the odontoid ligaments, leading to hyperextension of the head. Notably, minimal upward translation was observed.

These biomechanical factors subsequently contributed to the trauma, involving compression of the posterior components and separation of the anterior components of the upper cervical spine, accompanied by shear load from the torso mass. Consequently, this compression resulted in bilateral fractures of the posterior arch of the atlas.

A biomechanical study reported in the literature explored type II and high type III odontoid fractures, along with associated soft tissue injuries and atlantal fractures. These findings have implications for future flexibility testing protocols to assess different stabilization techniques for the upper cervical spine.

The optimal treatment for upper cervical spine injuries, particularly type II odontoid fractures, remains a subject of clinical debate. Specimens with specific fracture orientations can be valuable for investigating the effectiveness of anterior odontoid screw fixation in providing postoperative stability while preserving natural motion.

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Based on 107 reviews
Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
Dave
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
Eclectic54
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
Sam
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18
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I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.