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In Figures A-E, which of the following fracture patterns is at greatest risk for nonunion with nonoperative treatment?
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A 37-year-old male was involved in a motorcycle accident. He is neurologically intact. A coronal and sagittal CT scan is shown in Figure A. What is the most appropriate management?
Posterior C1-C2 fusion
Anterior odontoid screw fixation
Transoral anterior odontoid resection
Cervical immobilization for 6-8 week in an external orthosis
Treatment in a soft cervical orthosis for two weeks followed by range of motion exercises
In patients who are neurologically intact, all of the following cervical spine injuries can be appropriately managed with external immobilization in a rigid cervical orthosis EXCEPT
A young boy is involved in a motor vehicle accident and presents with neck pain. A CT scan is performed and is negative for fractures. Based on the presence of the ossification center shown in Figure A, what is the most likely age bracket of this patient.
< 1 years of age
1-3 years of age
3-6 years of age
8-10 years of age
> 12 years of age
In elderly patients with type II odontoid fractures, which of the following treatment modalities has the highest morbidity and mortality?
Hard cervical collar
Anterior screw osteosynthesis
Halo vest immobilzation
Posterior cervical stabilization
Soft cervical orthosis
A 67-year-old male smoker was involved in a motor vehicle accident and presents with neck pain. On initial presentation his neurologic exam was intact. Injury films are shown in Figure A and B. The patient was evaluated and surgical treatment was recommended. The patient left the hospital against medical advice. Seven months later he returns with continued neck pain. His current neurologic exam shows no deficits. A current CT scan and MRI is performed and shown in Figure C and D. What is the most appropriate treatment at this time?
Physical therapy and NSAIDS
Hard Cervical Orthosis
A 45-year old male is involved in a motor vehicle accident and presents to the emergency room with complaints of neck pain. Physical exam shows he is an ASIA E. An open-mouth cervical radiograph is shown in Figure A. A sagittal CT scan is shown in Figure B. A CT axial angiogram is shown in Figure C. Which of the following treatment options is contraindicated in this patient.
Anterior screw osteosynthesis with single cannulated screw
Anterior screw osteosynthesis with two cannulated screws
C1-C2 transarticular screws
Posterior C1-C2 wiring with autograft
A 36-year-old male falls while intoxicated two weeks ago and has had persistent neck pain ever since. For unclear reasons he did not seek medical attention. He now reports persistent neck pain, but denies symptoms in his upper and lower extremities. On physical exam he has Grade 5 motor strength in his upper and lower extremities, normal reflexes, and his sensory exam is normal. A CT scan is shown in Figure A. All of the following place this patient at an increased risk of nonunion EXCEPT:
Fracture gap of 2 mm
Posterior displacement of > 5mm
Delay in treatment of 2 weeks
Age < 40 years
HPI - The patient is an 81-year-old female that was involved in a MVA and sustained a Type 2 odontoid fracture. An initial attempt at nonoperative treatment with a hard cervical orthosis was attempted for three weeks. However, the patient had continued severe pain in the neck, and was having troubles tolerating the cervical orthosis. Therefore, after a conversation with the patient regarding the pros and cons of surgery, we elected to proceed with anterior screw osteosynthesis.
How would you have treated this Type II odointoid fx?