Odontoid fracture in motor vehicle environments.

The National Automotive Sampling System (NASS) and Crash Injury Research and Engineering Network (CIREN) databases were used in an analysis of odontoid fracture in motor vehicle crashes. NASS data were evaluated for the years 1996-2002, and CIREN from 1996 to 2003. Out of 58 fractures, 38 were identified in the NASS and 20 in the CIREN databases. There were 3108 weighted cases in the NASS database. Frontal impacts (11:00 to 1:00 h) were most commonly associated with the injury in both databases. Although male and female occupants sustained the injury, females were shorter in stature, older in age, lighter in weight, and crashes were less severe (lower change in velocity) when female occupants were involved in trauma. In both databases, pure odontoid fracture and facet/lamina fracture accounted for approximately one-third of the cases, and a majority of impacts were associated with changes in velocity less than 56 km/h. Although vehicle model years ranged from 1976 to 2002, recent model years were more frequently associated with CIREN data. In the CIREN database, type II odontoid fracture was the most common, but no particular mechanism of injury dominated; such information was not available in the NASS database. To ameliorate odontoid fracture, focus should be on frontal impacts. Because different types of odontoid fracture are not included in the current Abbreviated Injury Scale, appropriate coding schemes should be developed to classify this injury. The CIREN database is unique because it provides important clinical information, i.e., fracture type, and the associated mechanism of injury. The mechanism component in any epidemiologically based injury analyses is valuable to advance improvements in vehicle crashworthiness.