Cervical spine injuries represent a minority of injury cases in motor vehicles accidents but are a real threat to a patient’s life. In the wide range of cervical spine injuries, odontoid (dens) fractures represent the most common findings. These fractures are more usually found in the elderly population due to the changes associated with age. Neurological deficit is not frequently found in these injuries. The following is a case presentation of a chronic odontoid fracture with neurological deficit in a young man that was discovered 23 years after he sustained a motor vehicle accident. 1. Introduction It has been reported that the cervical spine is injured in 2.4% of blunt trauma victims [1]. Odontoid fractures account for 9% to 15% of cervical fractures in trauma [2, 3]. More specifically, type II in the Anderson and D’Alonzo classification [4] represents the most common of all odontoid fractures, which are considered unstable fractures. In this type of fracture, the fracture line is at the junction of the odontoid base and the body of the axis (C2 vertebrae) [4]. Neurological deficit is uncommon in patients with odontoid fractures [5]. If the deficit is present, it is most common in male patients that have sustained high velocity injuries and also are at higher risk of dying [6]. The scientific literature has reported that the frequency of missed injuries in the cervical spine varies from 4% to 30% [7, 8]. This paper presents a case of a patient with a chronic odontoid fracture who developed a pseudarthrosis (pannus) of bone during fracture healing that sustained a high-velocity injury in a motorcycle accident 23 years before presenting to the emergency department. The case reported here mixes uncommon conditions in odontoid fracture: a missed fracture of the odontoid process, neurological deficits, and the 23 years span between the fracture and the deficit. 2. Case Presentation A 37-year-old male patient presented to the emergency department complaining of loss of strength in his upper right arm, right hand, and paresthesias along the arm. He also complained of neck pain that has been going on and off for about 2 years. The neurological symptoms appeared three months prior to the consultation. General examination was unremarkable. The initial neurological exam showed an upper right limb paresis, and the rest of the exam was normal. The patient had no recent travels, and lived with his wife and a son. The patient referred had no recent trauma to the head or the neck or any type of vehicle accident. The initial clinical suspicion was a spinal cord
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