599 - Breaking Bad: A Case of Type-3 Odontoid Fracture

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

JL

Jack E. Leal, DO

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States

Co-Author(s)

JE

Jenzel Espares, DO

PM&R Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
AR

Aniroodh Reddy, MD

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
DM

Diane N. Moya, DO

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
KS

Kanwardeep Singh, MD

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
TP

Thomas Pobre, MD

Attending Physician
Nassau University Medical Center
East Meadow, New York, United States

Case Diagnosis: Type-3 odontoid fracture following mechanical fall.

Case Description: A 83-year-old male was admitted to the acute inpatient rehabilitation service following a mechanical fall at home resulting in odontoid and clavicular fractures. Upon initial presentation to the emergency room, the patient complained of severe, sudden onset, neck pain beginning immediately post-fall. On examination, the patient was found to be neurologically intact without reproducible neck tenderness. Spine imaging revealed a minimally displaced type-3 odontoid fracture with extension into the C1-C2 facet joint. The orthopedics service was consulted and, given the stability of the fracture, recommended non-operative management with a hard collar to be worn for 3 months. Following orthopedic clearance, the patient was later transferred to the acute rehabilitation service.

Discussions: Odontoid fractures, involving the second cervical vertebra, can be particularly challenging when they are of Type 3 variation. These fractures extend into the body of C2 and are relatively less common than Types 1 and 2, but carry a significant risk of instability due to their location and potential disruption of critical spinal ligaments. Type 3 odontoid fractures often result from cervical hyperextension in the setting of high-energy traumas, and their diagnosis relies on imaging studies to assess the extent of the fracture and associated ligament damage. Treatment options often necessitate surgical intervention, however cases without spinal instability or neurologic features may be managed conservatively with cervical bracing. In the latter case, the physiatrist plays an important role in guiding therapy regimens that observe orthopedic restrictions while supporting neck stability and aiding the patient's return to daily activities with reduced pain and discomfort.

Conclusions: This case illustrates a unique instance of a type-3 odontoid fracture and the important role physiatrists play in directing rehabilitation for cases managed non-operatively.