THE SIGNIFICANCE OF NONUNION IN TYPE II ODONTOID FRACTURE TREATMENT

The second type of dens fracture, according to the An­derson and D’Alonzo classification, is the most preva­lent among the three types, accounting for 60-80% of all cases. It is characterized by instability, and the fracture line extends to the base of the odontoid process. Type II fractures can be managed through conservative appro­aches involving both rigid and non-rigid immobilization or through surgical intervention. When treated conserva­tively, the rate of nonunion ranges from 50-85%, which decreases to 10-30% when surgical treatment is admi­nistered. There is no united consensus on the primary objective of treating Type II odontoid fractures. Some authors debate whether the goal should be achieving os­seous union, ensuring fracture stability, or improving cli­nical outcomes. Certain studies suggest that the frequent complications associated with surgical treatment, without a proven survival benefit, indicate that most patients may be better off with conservative management. On average, around 9.9% of patients shift from non-operative to sur­gical intervention due to several factors, including radio­logical findings, with the aim of averting the occurrence of future pain or neurological complications. While it is generally accepted worldwide to surgically treat patients with unstable nonunion, persistent neck pain, or neuro­logical symptoms, there is no consensus on how to ma­nage stable nonunion or even asymptomatic nonunion. Recent research studies suggest that radiologically stable nonunion, in the absence of persistent neck pain and ne­urological symptoms, might be a satisfactory outcome for patients aged 65 and older.