Fractures of the odontoid process. Incidence and treatment in the Neurosurgical Department of a hospital in Maputo (Mozambique)

Fractures of the odontoid process make up between 10 and 15% of all cervical fractures. The decision as to when to operate on them is still controversial; the dilemma as to whether to use surgical or conservative treatment is still a problem. We designed a descriptive study, which was prospective and applied to all patients diagnosed as having a fracture of the odontoid process, admitted to the Neurosurgical Department of Maputo Central Hospital (Mozambique) between June 1997 and May 1998. Follow up was rigorously controlled up to May 2000. All were treated conservatively with a cervical plaster collar. Six cases (83.3%), mainly male, were diagnosed. The patients were aged between 17 and 42 years, with an average age of 26.16 years. The commonest aetiology was a traffic accident (66.6%). Type II fractures were the commonest, seen in 4 patients. All patients complained of pain in the back of their necks. Dysparesia and brachial monoparesia were both seen in 33.3% of the patients. In four cases the fracture consolidated in three months, one in two months and the other after four months. Full recovery was made by 66.6%. Based on their review of the literature and own practical experience, the authors recommend conservative treatment for fractures of types I and II, immediate surgical operation for type IIA and for type II when the following conditions are met: displacement of over 4 mm, age of over 40 years and diagnosis made over a week after the injury had occurred.