OBJECTIVE: The aim of this study was to review the results of non-operative
treatment of odontoid fractures in Steve Biko Academic Hospital, Pretoria.
METHODS: Records for all patients treated for odontoid fractures from 2008 to
2018 were reviewed. 28 patients met the study criteria. Demographic data,
mechanism of injury, associated injuries, neurology, imaging studies and
treatment were reviewed. RESULTS: There were 23 males and 5 females. The
average age at presentation was 39.5 years. 25 patients were injured in road
traffic accidents. Associated injuries were present in 21 patients, mostly involving the spine and head. 18 fractures were classified as Type II and 15 as
Type III. Fracture comminution (5), angulation (6) and translation (10) were
noted. Primarily treatment modalities were cones callipers, Philadelphia
collar or halo vest. Fracture union was assessed radiologically at 3, 6 and 9
months. Type II and III fractures had high union rates at 6 and 9 months.
Significantly displaced fractures had a statistically lower union rate (p =
0.0285) at 6 months. CONCLUSION: Minimally displaced odontoid Type II and
III fractures can be effectively treated non-operatively in young adults. Extent
of fracture displacement is the single important factor in non-union rate.