Fixation of odontoid fractures by an anterior screw

Abstract

We have reviewed 81 patients with fractures of the odontoid process treated between May 1983 and July 1997, by anterior screw fixation. There were 29 patients with Anderson and D'Alonzo type-II fractures and 52 with type III. Roy-Camille's classification identified the direction and instability of the fracture. Operative fixation was carried out on 48 men and 33 women with a mean age of 57 years. Associated injuries of the cervical spine were present in 15 patients, neurological signs in 13, and 18 had an Injury Severity Score of more than 15. Nine patients died and 11 were lost to follow-up. Of 61 patients, 56 (92%) achieved bony union at an average of 14.1 weeks. Two patients required a secondary posterior fusion after failure of the index operation. A full range of movement was restored in 43 patients; only six had a limitation of movement greater than 25%. We conclude that anterior screw fixation is effective and practicable in the treatment of fractures of the dens.

Results of Long-Term Follow-Up in Patients Undergoing Anterior Screw Fixation for Type II and Rostral Type III Odontoid Fractures

“…With these limitations in mind, we used strict radiographic criteria for defining fusion because this had been done in previously reported clinical series of anterior odontoid screw fixation. 30,37,38,45,48,53,56,57 In our series, the long-term fusion rate (87%) was comparable with the reported ones from other large but short-term clinical series. Aebi et al, 30 using rigid radiographic fusion criteria similar to ours, reported an 88% fusion rate in a large series of type II and "shallow" type III odontoid fractures; the same fusion rate was accomplished by Apfelbaum et al 48 In a large clinical series, Henry et al 57 reported a 92% radiographically proven fusion rate; although it is noteworthy that in their series, patients with only acute type II and type III odontoid fractures were included.…”

Pooled Analysis of Non-Union, Re-Operation, Infection, and Approach Related Complications after Anterior Odontoid Screw Fixation

“…54 studies [12]–[20], [22]–[29], [31]–[51], [53]–[60], [62], [63], [65]–[70] that reported fusion results were pooled. Six studies [21], [52], [61], [72], [74], [75] were excluded from data synthesizing because of potential patients overlapping.…”

Komplikationen bei Densfrakturen

“…Abb. 2) F C1/C2-trans ar ti ku lä re Ver schrau bungen [37] F ver schie de ne Tech ni ken mit dor sa len Klam mern Die di rek te Ver sor gung mit Ver schraubung hat eine deut lich hö he re Fu si ons rate ge gen über der kon ser va ti ven Be handlung mit Halo und Or the sen [53] er reicht und bei den Typ-II-Frak tu ren gute Er gebnis se er zielt [19,24,26,33,40]. Das funktio nel le Re sul tat ist durch weg gut [52].…”