Isolated fractures of the axis in adults.

UNLABELLED: FRACTURES OF THE ODONTOID: STANDARDS: There is insufficient evidence to support treatment standards. GUIDELINES: Type II odontoid fractures in patients 50 years and older should be considered for surgical stabilization and fusion. OPTIONS: Type I, Type II, and Type III fractures may be managed initially with external cervical immobilization. Type II and Type III odontoid fractures should be considered for surgical fixation in cases of dens displacement of 5 mm or more, comminution of the odontoid fracture (Type IIA), and/or inability to achieve or maintain fracture alignment with external immobilization. TRAUMATIC SPONDYLOLISTHESIS OF THE AXIS (HANGMAN'S FRACTURE): STANDARDS: There is insufficient evidence to support treatment standards. GUIDELINES: There is insufficient evidence to support treatment guidelines. OPTIONS: Traumatic spondylolisthesis of the axis may be managed initially with external immobilization in most cases. Surgical stabilization should be considered in cases of severe angulation of C2 on C3 (Francis Grade II and IV, Effendi Type II), disruption of the C2--C3 disc space (Francis Grade V, Effendi Type III), or inability to establish or maintain alignment with external immobilization. FRACTURES OF THE AXIS BODY (MISCELLANEOUS FRACTURES): STANDARDS: There is insufficient evidence to support treatment standards. GUIDELINES: There is insufficient evidence to support treatment guidelines. OPTIONS: External immobilization is recommended for treatment of isolated fractures of the axis body.