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Type-III Dens Fracture with Distraction: An Unstable InjuryA Report of Three Cases
John S. Kirkpatrick, MD1; Todd Sheils, MD2; Steven M. Theiss, MD1
1 Division of Orthopaedic Surgery, University of Alabama at Birmingham, 940 Faculty Office Tower, 510 20th Street South, Birmingham, AL 35294-3409. E-mail address for J.S. Kirkpatrick: john.kirkpatrick@ortho.uab.edu
2 8229 Cedar Landing Court, Alexandria, VA 22306
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The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the University of Alabama at Birmingham, Birmingham, Alabama

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Nov 01;86(11):2514-2518
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Dens fractures have accounted for 7% to 17% of all fractures of the cervical spine in series of up to 625 cervical fractures1-5. In the classification system of Anderson and D'Alonzo, a type-III dens fracture extends downward into the cancellous portion of the body of the axis6 and typically heals without surgical intervention. After adequate reduction with traction, the use of a halo vest or halo cast has been associated with union rates of 80% to 100% in series ranging from twenty-one to 107 fractures1,4,5. Although displacement and/or dislocation2 of a dens fracture has been described in terms of translation or angulation, vertical displacement as a factor in determining stability or the adequacy of reduction has received little attention. Two case reports described vertical displacement of a type-III odontoid fracture7,8. Neurologic injury followed routine application of traction in both patients. The first patient became a ventilator-dependent quadriplegic, and the second died of complications from paralysis. The authors recommended aggressive surgical management when faced with this fracture pattern.
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