Odontoid process fracture, also known as a peg or dens fracture, occurs where there is a fracture through the odontoid process of C2.


The mechanism of injury is variable, and can occur both during flexion or extension, and with or without compression .


There are two classification systems

  • Anderson and D'Alonzo
    • most commonly used
    • describes level of fracture line (i.e. through tip, base, or lateral masses)
  • Roy-Camille classification
    • has been shown to better correlate with prognosis
    • describes plane of fracture and displacement

Differential diagnosis

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