Korean J Neurotrauma.  2014 Oct;10(2):149-151. 10.13004/kjnt.2014.10.2.149.

Traction Induced Vertical Displacement of Odontoid due to Type III Odontoid Fracture with Unrecognized Ligamentous Injury: A Case Report

• Jung MH
• Lee JK
• Hur H
• Jang JW
• Kim JH
• Kim SH

• KMID: 2256257
• DOI: http://doi.org/10.13004/kjnt.2014.10.2.149

Abstract

Dens fractures are a common traumatic cervical spine injury. Among them, a type III fracture is the second common fracture. Although there are several treatment options, it has been accepted that type III fracture is usually healed by non-surgical method. After adequate reduction with traction, subsequent external immobilization has been associated with successful union rates. However, in the review of literatures, there are some cases with neurological deterioration after application of skull traction. So, the authors report a case of type III dens fracture with initially unrecognized ligamentous injury in which vertical dissociation and quadriplegia occurred after only five-pound Gardner-Well tongs traction. And also, the authors raise awareness of this potentially injury.

Keyword

Cervical vertebrae; Fracture fixation internal; Traction

MeSH Terms

Cervical Vertebrae
Female
Immobilization
Ligaments*
Quadriplegia
Skull
Spine
Traction*

Figure

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  FIGURE 1 Lateral cervical radiograph revealing a type III dens fracture with slight anterolisthesis, angulation of dens, vertical displacement (A). A cervical spine computed tomography with 3D reconstructions revealing a type III dens fracture with extension into left facet joint, and separation between the fragments of axis (B).

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  FIGURE 2 Lateral cervical radiography (A) and computed tomography with 2D coronal reconstructions (B) revealing vertical displacement of axis greater than 5 mm.

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  FIGURE 3 Postoperative lateral cervical radiography revealing anterior tranodontoid screw fixation and unilateral C1-2 posterior transarticular screw fixation with wiring achieved reduction of odontoid fracture.

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  FIGURE 4 Cervical MRI revealing heterogeneous high signal intensity (consider to hemorrhagic contusion) in spinal cord of C3-T2 level (A) and extensive syringomyelia in thoracic spinal cord (B).

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