Ununited Mobile Odontoid Fracture: Clinical and Imaging Findings With Subsequent Management: A Case Report

Abstract

Objective

The purpose of this case study is to describe the clinical presentation and imaging evaluation of an acute type II dens fracture that failed to unite with immobilization. Subsequent management aimed at optimizing the patient’s quality of life is discussed.

Clinical Presentation

An 84-year-old male presented to a chiropractic clinic 4 days after a ground-level fall onto his face. He demonstrated facial bruising, severe pain of the neck and severely limited cervical rotation. Based on the clinical findings and history, the attending chiropractor suspected a cervical spine fracture.

Intervention and outcome

The chiropractor proceeded to take cervical spine radiographs which showed a type II dens fracture and anterior translation of C1. The patient was then transported to the hospital by ambulance, where computed tomography (CT) confirmed the presence of a type II odontoid fracture. Following immobilization, initially with a hard collar and later a soft collar, the dens fracture healed but with non-union. A magnetic resonance imaging scan with flexion and extension showed translation of the dens, however no spinal cord compromise was demonstrated. Surgery was not advised due to the patient’s age and lack of cord compromise. The chiropractor resumed management after medical clearance, focusing on fall prevention strategies, neck strengthening exercises and gentle soft tissue work.

Conclusion

Upright magnetic resonance imaging with flexion and extension was helpful for evaluation and further management of a non-united mobile type II dens fracture. Patients who experience non-union of type II odontoid fracture may benefit from conservative measures aimed at falls prevention, such as balance exercises, bone and heart health evaluation, muscle strengthening, cataract evaluation and scrutiny for hazards in the home.