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Fractures of the odontoid peg of the axis (C2) may result from extension of the neck in a high-velocity accident or a severe fall. They are difficult to diagnose and should be suspected from the history in association with local pain and protective muscle spasm.
In the majority of cases the diagnosis is confirmed on AP 'through the mouth' and lateral x-rays. In some cases tomography may be necessary. Confusion may arise because of congenital abnormalities including non-fusion of the odontoid process. Be careful not to mistake the vertical cleft between the incisors or the epiphyses in children for a fracture.
Odontoid fractures can be classified as follows: