• Asdrubal Falavigna, Orlando Righesso, Pedro Guarise da Silva, Carlos Rocca Siri, Jefferson W Daniel, Esteves Veiga José Carlos JC Division of Neurosurgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil., de Azevedo Gustavo Borges Laurindo GB National Institute of Traumatology and Orthopedics of Rio de Janeiro, Rio de Janeiro, Brazil., Luis Eduardo Carelli, Ratko Yurac, Felix Adolfo Sanchez Chavez, Ericson Sfreddo, Andre Cecchini, Marcelo Martins do Reis, Jose Maria Jiménez Avila, and K Daniel Riew.
• Neurosurgery Department, Caxias do Sul University Medical School, Caxias do Sul, Brazil. Electronic address: asdrubalmd@gmail.com.
• World Neurosurg. 2017 Feb 1; 98: 673-681.

ObjectiveTo analyze characteristics of type II odontoid fracture (TII-OF), including clinical and radiographic factors, that influence surgical planning in 8 Latin American centers.MethodsRetrospective chart review was performed of 88 patients with TII-OF between 2004 and 2015 from 8 Latin American centers. Parameters studied included 1) demographic data and causes of TII-OF, 2) clinical and neurologic presentation, 3) characteristics of fracture (degree of odontoid displacement, displacement of odontoid relative to C2 body, anatomy of fracture line, distance between fragments, presence of comminution, contact area between odontoid and C2 body), 4) type of treatment, and 5) clinical and radiographic outcome. Bone fusion was assessed using computed tomography.ResultsMean patient age was 45.33 years ± 23.54; 78.4% of patients were male. Surgery was the primary treatment in 65 patients (73.8%), with an anterior approach in 64.6%. Surgery was usually preferred in patients with posterior or horizontal oblique fracture lines, local pain, and a smaller bone contact surface between the odontoid and the body of C2. A posterior approach was chosen when distance between the fractured bone fragments was >2 mm or after failed conservative or anterior odontoid screw treatment in a symptomatic patient.ConclusionThe treatment of choice for TII-OF in 8 Latin American trauma centers was surgery through an anterior approach using screw fixation. Posterior segmental C1-C2 fixation was indicated when distance between bone fragments was >2 mm and in symptomatic patients with nonunion.Copyright © 2016 Elsevier Inc. All rights reserved.

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