Hyperbaric oxygenation as a successful therapeutic approach in oral wound dehiscence after operative stabilization of an unstable post-traumatic odontoid non-union

Abstract

The non-operative treatment of unstable traumatic Anderson's type II odontoid fractures has a high risk potential to develop non-unions. Even after operative stabilization literature reveals non-union rates up to 20%. Acute life threatening complications are tetraplegia and apnoea. Long-term complications induce chronic myelopathy resulting from persistent myeloradicular compression. We report the case of a patient with a 17-year-old post-traumatic pseudarthrosis of the dens axis following conservative treatment of an unstable type II fracture. By that time, the female patient, then 37 years old, was admitted to our hospital with early signs of cervical tetraplegia. After initial reposition and short-term immobilization with a halothoracic vest we performed a ventrodorsal atlantoaxial spondylodesis. Failure of anterior cervical plate stabilization and autologous graft resorption without a solid segmental fusion instigated a secondary surgical intervention. Postoperative therapy-resistant oral wound dehiscence showed an exposed autograft and osteosynthetic material. The reported positive effect of hyperbaric oxygenation on wound healing in problem cases led us to attempt this means of therapy. With a daily exposure to hyperbaric oxygenation, the dehiscence closed within 25 days. As a result of our experience in this case, hyperbaric oxygenation should be considered as a therapeutic option in postoperative complication management in orthopaedic surgery.

Anterior endoscopically assisted bone grafting for iatrogenic distraction of odontoid fracture after percutaneous anterior screw fixation

“…[ 1 – 3 ] According to the classification of Anderson and D’Alonzo, [ 4 ] almost 60% of these fractures are type II cases that are associated with a high incidence of nonunion. [ 1 , 2 , 5 – 7 ] The reported nonunion rate with no treatment is nearly 100%, [ 7 , 8 ] and the nonunion rate in conservative treatments ranges from 40% to 75%, [ 3 ] even in patients with surgical stabilization the nonunion rates are up to 20%. [ 8 ] Odontoid nonunion is a potentially serious complication.…”

“…[ 1 , 2 , 5 – 7 ] The reported nonunion rate with no treatment is nearly 100%, [ 7 , 8 ] and the nonunion rate in conservative treatments ranges from 40% to 75%, [ 3 ] even in patients with surgical stabilization the nonunion rates are up to 20%. [ 8 ] Odontoid nonunion is a potentially serious complication. Therefore, surgical fixation is advised by most surgeons in type II odontoid fracture.…”

Hyperbaric Oxygen Stimulates the Proliferation and Differentiation of Raw264.7 Cells

“…Therefore, it is important to determine the effect of HBO on bone regeneration. Although animal studies have shown that HBO can be used to treat delayed fracture healing [12]- [14] or an established nonunion of a bony fracture [12] [15] [16], the clinical application of HBO is still subject to debate [12] [17]- [19] due to the lack of in vitro studies, for example, to demonstrate its effect on osteoclast activity.…”