Combined double fracture of the odontoid process and fracture of the atlas

We report a rare case of double fractures of the odontoid process combined with a fracture of the anterior arch of the atlas. Combined fractures of the odontoid process and the upper cervical spine are not unusual. The presence of two different patterns of odontoid process fractures combined with a fracture of the anterior arch of the atlas is not reported in the literature available to us. The authors report on a patient who sustained two fractures in the odontoid process of C2 and a fracture of the anterior arch of C1. As the initial plain films were not clear enough to detect suspected lesions in the upper cervical spine, the patient underwent full investigation with CT scan and MRI. Reconstructive images showed the fractures of the odontoid process and the one of the atlas. The patient was treated conservatively with the application of cranial traction. The patient died 10 days later of unrelated cardiopulmonary insufficiency. During this period, there was no particular problem from the cervical spine. We recommend a high level of alert and suspicion to every case of upper cervical spine injury since, due to the complexity of the anatomy of this transitional area, a different biomechanical behavior exists leading to a variety of combination of fractures. © Springer-Verlag 2004