Fracture of the odontoid process in a male individual from the medieval necropolis of Maro (Málaga, Spain)

Traumatic injuries are commonly reported in paleopathology. However, fractures of the odontoid process in past populations are uncommon and therefore such injuries may be easily overlooked. This paper describes alterations of the first and second cervical vertebrae, the atlas and axis, of a male individual of advanced age from the medieval necropolis of Maro (Málaga, Spain). These alterations were observed through macroscopic evaluation and radiological analysis. This individual's skeleton is well-preserved, with degenerative changes present in the appendicular skeleton and the rest of the vertebrae. Our differential diagnosis included aplasia of the dens, bifid dens, dens duplicated, ossiculum terminale persistens, os odontoideum, and odontoid process fractures. We concluded that the most likely condition was a broken odontoid process fused with the anterior arch of the atlas, a pseudarthrosis demonstrating that the individual survived this fracture. This study is one of the first reports of an odontoid process fracture in ancient contexts.