• Alberto Debernardi, Giuseppe D'Aliberti, Giuseppe Talamonti, Fabio Villa, Maurizio Piparo, and Marco Cenzato.
• Department of Neurosurgery, Niguarda Cà Granda Hospital, Milan, Italy. albertodebernardi@hotmail.it
• World Neurosurg. 2013 May 1;79(5-6):779-83.

ObjectiveTraumatic (Type II) odontoid fractures are very common injuries. Nevertheless, their connection with transverse atlantal ligament injury is controversial and poorly defined. The aim of this study is to report a single case of traumatic (type II) odontoid fracture with transverse atlantal ligament injury and to critically analyze the role of ligaments and membranes together with neuroradiological tools in the management of craniovertebral junction-traumatized patients.MethodsWe report 27 consecutive cases of traumatic (type II) odontoid fractures who underwent magnetic resonance imaging (MRI) in the acute phase injury (<72 hours), focusing our attention on the transverse atlantal ligament.ResultsOne patient (3.7%) demonstrated a transverse atlantal ligament injury on MRI. The patient underwent surgery.ConclusionsTraumatic (type II) odontoid fracture with transverse atlantal ligament avulsion can be considered an unusual event. It is our opinion that the routine use of MRI for all patients with type II odontoid fracture could be unjustified in clinical practice. Strict clinical surveillance of all patients managed conservatively and the use of MRI in selected cases could be a reasonable management option.Copyright © 2013 Elsevier Inc. All rights reserved.

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