Odontoid Fractures

  • common
  • occur at an average of 4 years of age
  • this is a physeal  injury of the synchondrosis
  • infrequent neurologic injury
  • usually the displacement is anterior like head falling forward
  • bony syndromes including Morquio, NF, Osteogenesis Imperfecta etc. can give dysplastic appearance & make the diagnosis difficult
  • results of nonoperative treatment are much better in children, perhaps because of an anteriorly intact hinge
Odontoid Fractures, ct of an odontoid (dens) fracture
CT of an odontoid (dens) fracture. Image by James Heilman, MD, Wikimedia Commons, CC BY-SA 3.0.

Treatment

  • generally consists of reduction with hyperextension in the recumbent position & then Minerva jacket or Halo for 6 weeks
  • follow up X-rays are required to check union & stability
  • rare to need halo traction for reduction

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.