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Case A: A sharp, radiolucent dens fracture line without cortication is evident, separated by a very narrow fracture gap from the “matching” donor site. Prominent prevertebral swelling is seen.
Case B: A smooth, well-corticated, oval-shaped os odontoideum is seen at the expected site of the dens, with a wide gap separating it from the remainder of C2. Note the presence of a hypertrophic anterior arch of C1 and that the borders of the os do not directly match up with the remainder of C2. In addition, notice the presence of a narrow, interdigitating joint line between the os and the hypertrophied anterior arch of C1 (the “jigsaw sign”).
Case C: A sharp, radiolucent, narrow gap, dens fracture line is evident, with sclerosis along the fracture fragments and mild posterior displacement.
Case D: The patient had a prior C3-C4 anterior cervical diskectomy and fusion, as noted in the history. A small, smooth, well-corticated, oval-shaped os is seen along the superior aspect of the dens. The dens does not appear to be nearly as prominently truncated as in Case B.
Acute type II dens fracture
Os odontoideum (orthotopic)
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