Fixation of odontoid fractures by an anterior screw

Abstract

Fracture of the odontoid process of the axis is a common injury. Its treatment remains controversial. Nonunion, stiffness of the neck, cervical myelopathy and poorly tolerated external fixation are some of the problems associated with treatment.Current Surgical treatment of the fractured dens has usually been carried out by way of a posterior fusion of C1 and C2, with excellent rates of bony union between them. It is, however, associated with considerable mortality and morbidity and results in a decrease in the range of movement of the neck. 20-25The classification of Anderson and D'Alonzo 7 provides a guide to prognosis for healing. Type-I and type-III fractures give a good rate of union, while type II has a poor prognosis. Roy-Camille et al 26 analysed prognostic factors concerning the initial displacement, obliquity of the fracture, and rotational deformity (the 'Bobby-helmet' fracture). Horizontal or posterior oblique fracture lines, posterior displacement, and rotation deformity are all bad signs. Other factors associated with nonunion are age, 13,23 posterior displacement, 13,27 the degree of displacement, 3,11,13,23,28 fractures through the waist 3,7,11,13,26,29 and inadequate immobilisation. 3Reports by Nakanishi et al 30 and by Böhler 31 describe a direct anterior approach using a screw to fix the fractured dens. Between 1987 and 1991 further studies described the use of this technique. [32][33][34][35][36][37] The rates of union are comparable with those for C1 to C2 fusion, with few complications and good functional results. 32,34,35,38,39 We have reviewed a series of 81 patients to establish the place of anterior screw fixation in the treatment of fractures of the odontoid process. Patients and MethodsWe included all patients with fractures of the dens, treated by anterior screw fixation between May 1983 and July 1997. There were 48 men and 33 women. Their mean age at presentation was 57 years (15 to 92). We found a marked difference in age distribution according to gender; 67% (32) of the men were younger than 60 years, while 88% (29) of the women were over this age. The causes of the injury were motor-vehicle accidents (20 patients), motorcycle accidents (6), pedestrians being hit by cars (6), falls

Safety and Efficacy of Anterior Odontoid Screw for the Management of Odontoid Fractures. A Series of 22 Patients.

“…Our bony healing rate is reportedly lower than that reported in other series 2,4,5,10,13,16,19,20,22,23,25,26,32 ( Table 6). This may be related to a number of factors.…”

Computed tomographic evaluation of odontoid process: implications for anterior screw fixation of odontoid fractures in an adult population

“…The anterior odontoid screw fixation technique was originally described with two screws [3,5]. However, there has been debate over whether one or two screws is optimal for fracture fixation [7,12] and whether it is always possible to use two screws for anterior odontoid fixation [10,14].…”

Efficacy of anterior odontoid screw fixation in the elderly patient: a CT-based biometrical analysis of odontoid fractures

“…Julien et al [14] reviewed a mean overall union rate of 85.5% with posterior instrumented fusion of C1-2, while the fusion rates after AOSF were reported with 95, 90% for Type II and 100% for Type III. The results were echoed in several other studies with fusion rates ranging 84-96% [14][15][16][17][18][19][20][21][22][23][24][25].…”

“…First described by Bohler [13], several studies also reported on technical details, surgical outcomes and complications [2,6,[14][15][16][17][18][19][20][21][22][23][24][25]. AOSF allows osteosynthesis of reduced OF through a non-traumatic standardized surgical approach if compared to the posterior approach [26] and can preserve atlantoaxial motion.…”

“…Contraindications such as remote or compound fractures have to be respected for successful surgery [6,27]. Using AOSF, overall fusion rates were reported with up to 84-96% [14][15][16][17][18][19][20][21][22][23][24][25] and 23-93% in the elderly population [6-11, 28, 29]. The impact of patients' age at index surgery on outcome was discussed controversially.…”