An Elderly Odontoid Fracture Caused by a Minor Traumatic Event

Trauma specialists who are engaged in trauma and critical care medicine normally treat patients with highenergy injuries. However, odontoid fracture occurs in relatively high frequency at cervical area. Odontoid fracture is potentially life-threatening type of cervical injury. It might eventually stop the breathing due to displacement of spinal cord, often resulting in fatal condition. It has been estimated in 10%1 of the cases, hence evaluation of the cervical spinal need to be considered which may otherwise get overlooked in minor cases of fracture. We report the case of an 82-year-old woman who fell down during walking which is a minor event. She knocked the back of her head, and it became hard to move the neck without pain. She was transported by ambulance without support to cervical spine. She had no motor or sensory disturbance. But had mild osteoporosis, and on Teriparatide therapy by subcutaneous injection (20 microgram/day). She presented to the emergency room (ER) with hemodynamically stable state with clear conscious level. Her physical examination showed slight tenderness on left side of neck, however, no neurological abnormality. She revealed no wounds to the head. Brain computed tomography (CT) detected no abnormalities of acute injury. Nevertheless, cervical CT showed odontoid fracture, Anderson type 2 (Figure 1-A, 1-B and 1-C). The orthopedist continued to use a neck brace to support the patient’s neck and head. The patient was hospitalized overnight and discharged the following day. Subsequently, the patient had appointment to visit the orthopedic clinic. Based on this incident, it may be pertinent to note that although neck pain could be a daily minor issue, it ought to be taken seriously. Firstly, continuous pain, tenderness of the neck and motor disorders are important symptoms of odontoid fracture, hence this diagnosis had to be considered even in a minor injury,