# Surgical Management of Type II Odontoid Fractures in a Resource-Limited Setting: A Case Series

## TL;DR

This paper presents alternative surgical techniques for treating type II odontoid fractures in a resource-limited hospital in the Democratic Republic of the Congo.

## Contribution

The study introduces adaptive surgical methods suitable for underresourced settings to manage type II odontoid fractures.

## Key findings

- Non-cannulated orthopaedic screws and image intensifiers were successfully used for anterior odontoid fixation.
- Partial resection of the C1 posterior arch followed by immobilization was effective for a neglected fracture.
- All three patients had satisfactory neurological outcomes with no postoperative complications.

## Abstract

Type II odontoid fracture, classified by Anderson and D’Alonzo, is the most common traumatic injury to the odontoid process. Surgical management of this lesion is particularly challenging in underresourced countries. This study aims to report the preliminary experience of the Kinshasa University Teaching Hospital in Kinshasa, Democratic Republic of the Congo, particularly using adaptive techniques. Three patients, aged 22, 30, and 32 years, respectively, were admitted to the neurosurgery department with Anderson and D'Alonzo type II odontoid fractures as confirmed by CT scan imaging. The first two patients underwent anterior odontoid fixation using a non-cannulated orthopaedic screw with an image intensifier. In the third case, partial resection of the C1 posterior arch was performed, followed by immobilisation using a rigid Philadelphia neck brace. Postoperative follow-up in all three cases was uneventful, and neurological outcomes were satisfactory. Odontoid surgery remains challenging for developing countries. The use of a non-cannulated orthopaedic screw for anterior fixation and posterior spinal cord decompression via partial resection of the C1 posterior arch, followed by external cervical immobilisation with a rigid neck brace for neglected fractures, could be effective alternatives to conventional surgical techniques. However, randomised multicentre studies are required to confirm the efficacy and safety of these techniques.