Type II odontoid fracture with complete posterior dens displacement: Manual reduction and anterior screw fixation

Background: Type II odontoid fractures with significant dens displacement are frequently treated with surgical fixation, most commonly through posterior cervical approaches. However, extensive posterior soft tissue injury may limit the feasibility of posterior fixation and require alternative anterior odontoid fixation. Case Description: A 61-year-old male sustained a type IIA odontoid fracture with complete posterior dens displacement following an electrical burn injury and fall. Extensive burns involving the posterior neck/back precluded posterior cervical fixation (i.e., high risk of infection and wound complications). Following manual reduction, a single anterior odontoid screw was placed for C1/C2 stabilization. Postoperative imaging demonstrated appropriate screw positioning and restoration of the atlantoaxial alignment complex with preservation of transverse ligament integrity. Conclusion: Anterior odontoid screw fixation provided effective C1-C2 stabilization in this 61-year-old male with a type II odontoid fracture where posterior fixation was contraindicated due to severe burns to the posterior cervical region.