In young adults, the fractures occur most often due to high energy trauma including motor vehicle crashes and in the elderly with low energy trauma commonly due to fall from standing height. Odointoid fracture has a bimodal distribution involving early childhood and the elderly age group. They represent the most common cervical spine injury of patient older than 70 years. Odontoid fracture accounts for approximately 15% - 20% of all fractures of cervical spine. Surgical treatment is associated with little advantage but should be selected with proper attention to age, comorbidities, fracture geometry and it is better to individualize the treatment strategy. Conservative treatment of this fracture in the elderly should preferably be carried out with hard collar or avoiding halo vest. Though surgical treatment has a better outcome, it is also limited by the co-mobidities and hazards of anesthesia and surgery in elderly patients. Current studies suggest that surgical management of odontoid fractures may offer a protective benefit but it is limited to patients younger than 75 years of age. When conservative treatment of this fractures is indicated that should be carried out with hard cervical collar or cervicothoracic orthosis. Nonoperative treatment with halo vest is associated with very high rate of complication in elderly patient. Objective of this review is to find a controversial aspect of management along with opinion to find out a standard guideline by searching the literature in Pubmed and Google scholar databases with key words : odontoid, fracture, type-2, management, nonoperative and operative management. Management of odontoid fracture cannot be standardized till to date and ideal treatment for type-2 odontoid fractures still ha s some controversial issues. This injury is associated with a high incidence of morbidity, mortality and nonunion in the elderly irrespective of mode of treatment. Among the odontoid fracture, type-2 fracture is the most common variety. Despite a comprehensive search, the review authors found no evidence from completed randomised controlled trials to inform the choice between surgical and conservative management.Odontoid fracture accounts for 15% - 20% of all cervical spine injuries. The review aimed to examine the evidence from randomised controlled trials comparing surgical versus conservative treatment for these fractures to find if either approach gave a better outcome. Another option is surgical stabilisation of the fractured parts. People with these fractures are often treated conservatively, which entails stabilisation of the neck in devices such as a 'Halo' (external frame) and/or rigid collar for several months. In survivors there is a risk of ongoing damage to the spinal cord and paralysis. Fracture of the odontoid process is a serious injury and is often fatal.
Underneath this is the axis or second vertebra, which has a upward pointing process called the odontoid process around which the atlas can rotate, enabling the head to be turned. The first vertebra, called the atlas, supports the skull. The seven bones making up the neck region of the backbone are called the cervical vertebrae.