Dens Fracture – Causes, Symptoms & Treatment |

Dens fracture

The dens is part of the axis, the second cervical vertebra. This consists of a body with vertebral arches and transverse processes and a bone process, the thorn or tooth (dens). When an axis fractures (breaks) the dens is most commonly affected, which is why this type of fracture is called a dens fracture .

What is a dens fracture?

A dens fracture is a break in the bony process of the second cervical vertebra. According to the Anderson-D’Alonso classification, three different fracture types are distinguished. Various ligaments are attached to the dens axis, through which the movement of the cervical vertebrae is passed on to the muscles. One of these ligaments is the transverse ligament.

  • In a type I fracture, the tip of the dens axis is broken obliquely above this ligament.
  • Type II is the most common of the dens fractures. Here the fracture point runs near the dens base, close to the transition to the axis body.
  • Type III already extends into the body of the Axis.


Type I fractures are caused by overstretching of the ligamenta alaria. This can happen due to a serious injury with displacement of the head joints between the occipital bone and the first cervical vertebra. This leads to a tearing of the associated ligaments (ligamenta alaria), which causes the fracture.

Type II fractures often result from falls. Falls on the face result in hyperextension injuries, which shift the atlas backwards, and falls on the back of the head result in hyperflexion trauma, which causes the atlas to shift forwards. In both cases, a type II fracture can occur.

In type III, a violent impact causes a vertebral displacement. The ligament that surrounds the dens axis (ligamentum transversum) is massively stretched. If it does not rupture at this stretch, it transmits the applied force to the vertebra, causing it to rupture.

Dens fractures often affect older people because the bones become increasingly brittle in older people. In younger people, the bone structure is even stronger, which is why they are more likely to injure the ligaments.

Symptoms, Ailments & Signs

The anamnesis is particularly important here, as the types of injuries result from the course of the accidents. Injuries such as chin wounds, facial injuries and head lacerations can already indicate an injury in the cervical spine area.

If there is also a misaligned head and neck position, with pain and restricted movement of the upper cervical spine, there are even more indications of such an injury. Local tenderness as a main symptom on palpation suggests an upper cervical spine injury. Other symptoms include neck pain , difficulty swallowing and neurological deficits.


The diagnosis is made with imaging methods. This can be a conventional X-ray examination of the upper cervical spine in three planes, but computed tomography is more accurate . It makes injuries visible or clearer that are often either not recognized or underestimated in the X-ray image.


Dens fracture can cause complications and pain in different places around the neck area. In most cases, however, injuries occur in the cervical vertebrae. The patient suffers from limited mobility, since the movements of the head and neck often lead to pain.

This also greatly reduces the quality of life. There is pain in the neck and throat. This can occur as either rest pain or pressure pain. Difficulty swallowing is also common. It is no longer possible for the patient to do sports or physical activities, which restricts everyday life.

In the worst case, the dens fracture can also paralyze the respiratory center, which can lead to death. Treatment is usually through surgery and the use of fixation. Depending on the age, there can be various other complications, so that another operation may be necessary. The life expectancy is not reduced by the dens fracture if it is treated in time and the patient does not expose himself to any particular stress.

When should you go to the doctor?

Since this complaint is a broken bone, a doctor must be consulted in any case. If the patient does not see a doctor, complications can arise later if the bones do not grow together properly. As a rule, the doctor should be consulted if the patient feels very severe pain in the neck after an accident or after a blow.

A brief loss of consciousness can also indicate a dens fracture. Dens fractures also lead to significant limitations in movement and severe swallowing difficulties, making it difficult to eat. Even with these symptoms, a visit to a doctor is definitely necessary. Severe neck pain can also indicate a dens fracture and should therefore be examined. In acute emergencies or if the pain is very severe, the person concerned should go to a hospital or call an ambulance . Further treatment is then carried out by immobilising the affected region.

Treatment & Therapy

The type I fracture is considered stable and can be adequately treated with a cervical collar for one to two weeks. The type II fracture is critical. It is unstable and difficult to treat. Two treatment routes are available. As a conservative therapy, a halo vest is worn for twelve weeks.

The head is held in place by the halo vest and the fracture can heal. A cervical orthosis is increasingly being used instead of the halo vest . Older patients in particular have fewer difficulties with this. The fact that pseudarthrosis develops in 35 percent to 85 percent of all cases speaks against conservative therapy .

With conservative treatment, there is a risk of non-union. The frequency of pseudarthrosis is also given as 35 to 85 percent. Denspseudarthrosis harbors two major dangers. Acute paralysis of the respiratory center with tetraparesis (paralysis of all four limbs) or slowly increasing myelopathy can occur .

In the case of myelopathy, the spinal cord is progressively damaged by increasing pressure from the denspseudarthroses. Which can also lead to paralysis and even death. There are also patients with pseudarthrosis who are stable and have no symptoms. In the case of an untreated dens fracture type II, 100 percent of the cases result in a non-union.

Since conservative therapy is associated with many risks, surgery is increasingly preferred, even in elderly patients. An ideal surgical technique for stabilizing type II dens fractures has not yet been found. A dorsal screw connection of the cervical vertebrae C1 and C2 (Atlas and Axis) provides the greatest stability, but only limited movement of the head is possible.

Spin loss is 50 percent. In addition, during the operation there is a risk of injuring the vertebral artery and there may be a greater loss of blood during the operation. Another option is ventral Dens screw fixation.

There is no loss of rotation here and the patient can be mobilized more quickly, which is particularly important for older patients. Here, however, higher denspseudarthroses occur and up to 20 percent of the cases have to be operated on again. Stability can be improved with an additional ventral screw connection of C1 and C2.

With this fracture, the type of treatment is a matter of consideration. The decisive goal of therapy is rapid mobilization and reintegration of an old patient. Type III dens fractures can be treated conservatively. Pseudarthroses rarely form here and the patient has to wear a halo fixator or a cervical orthosis for ten to twelve weeks. Surgery is rarely necessary.

Outlook & Forecast

In the case of a dens fracture, those affected are dependent on treatment in any case. This disease does not heal itself and in many cases there is unbearable pain, so treatment is definitely necessary.

Those affected suffer from severe restrictions in movement and also from pain in the neck or head. This can lead to swallowing difficulties, with the pain often spreading to neighboring regions of the body. The patient’s quality of life is significantly reduced and limited by the dens fracture. In the further course, it can also lead to neurological deficits and sensory disturbances.

The treatment of dens fractures is always based on the exact complaints and symptoms and can limit them relatively well. The fracture is repaired with a surgical procedure. The surgical procedure is often no longer performed on older people, so that they are dependent on conservative therapy. Complete healing cannot occur and movement of the head remains restricted. As a rule, life expectancy is only reduced by a dens fracture if it negatively affects the patient’s respiratory function.


Dens injuries are mostly the result of accidents involving the head. Typical of this are traffic accidents or sports accidents, falls while riding or skiing, or even diving into unknown waters that are too shallow. A simple fall can be enough for old people.

Only adequate security measures offer protection. Reasonable behavior on the road. A roadworthy car with airbags, correctly adjusted headrests and good seat belts. Observe safety regulations during sport and at work and wear helmets and protective clothing. In the elderly, treating circulatory problems is important to prevent fainting and dizziness , which can lead to falls.


A dens fracture is a fracture of the cervical vertebrae that often occurs in older people when they fall forward. In order to be able to guarantee an optimal and complication-free course of the disease, regular examinations should be carried out by the doctor to be treated. Otherwise, there is a risk that this type of fracture will not heal properly.

If the affected person decides to visit the doctor regularly, then absolutely nothing stands in the way of a full recovery. The fracture can be fixed using ventral screw connections so that it can grow together firmly and stably. However, appropriate follow-up examinations are of great importance, since such foreign bodies can always cause complications.

If you want to avoid all complications, you should definitely resort to the aftercare examinations mentioned above. Regular visits to the doctor can ensure a full and timely recovery. However, if the person concerned completely refrains from such aftercare, serious consequential damage can even occur under certain circumstances.

A dens fracture is a clinical picture that should definitely be treated medically and with medication. Follow-up visits should also be done to allow for a full recovery. If these do not take place, the person concerned must expect considerable complications or permanent consequential damage.

You can do that yourself

If a dens fracture is suspected, a doctor must make the diagnosis and immediately initiate surgical treatment. After the operation, some self-help measures make everyday life with a dens fracture easier.

These primarily include rest and bed rest . The back and cervical vertebrae must not be put under strain in the first days and weeks after the operation. Further medical examinations are required to rule out neurological damage. If unusual symptoms are noticed, this must be discussed with the responsible doctor.

Accompanying this, physiotherapy and light sport, but also yoga or Pilates are available . Massages help against tension caused by splints. Long-term consequences are not to be expected from a dens fracture. Those affected have to adjust to pain and restricted movement, especially in the first few weeks and months after the accident or fall.

So that the return to everyday life goes smoothly, you should talk to other affected people. In forums and self-help groups, patients with a dens fracture receive tips on suitable sports, any dietary measures (especially in dens fractures type II) and possible accompanying symptoms. Because of this and conventional medical treatment, a dens fracture can usually be cured quickly and relatively painlessly.

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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.