Isolated Fractures of the Axis in Adults

Consideration of surgical stabilization and fusion for type II odontoid fractures in patients ≥50 years of age is recommended. (Level II, )

Initial management of nondisplaced type I, type II, and type III odontoid fractures with external cervical immobilization is recommended, recognizing that a decreased rate of union (healing) has been reported with type II odontoid fractures compared with type I or type III odontoid fractures. (Level III, )

Surgical stabilization and fusion of type II and type III odontoid fractures with dens displacement ≥5 mm, comminution of the odontoid fracture, and/or inability to achieve or maintain fracture alignment with external immobilization are recommended. (Level III, )

If surgical stabilization is elected, either anterior or posterior techniques are recommended. (Level III, )