A fracture of the odontoid process of the axis (C2) may fail to heal if certain risk factors are present.
Risk factors for nonunion:
(1) age of the patient > 40 years
(2) angulation of the fracture > 10 degrees
(3) posterior displacement
(4) displacement > 4 mm
(5) instability
where:
• Instability can be demonstrated under fluorscopy using flexion-extension stress views.
The presence of one or more of these factors may be associated with nonunion. A patient with one or more of these risk factors may benefit from an operation with fixation.
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