One or two screws offers similar stability for fixation for a dens fracture. One- or two-screw fixation was as stiff as primary C1-C2 wiring in bending. No significant differences were found between one- and two-screw fixation when compared with primary C1-C2 wiring in torsion. No significant differences were found between bending and torsional stiffnesses for the one-screw and two-screw specimens. prefer to undertake posterior transarticular facet screw fixation supplemented by bone graft and interspinous C1-2 wiring In cases of Chronic Type II odontoid fractures and in patients with transverse ligament disruption, Shilpakar et al. Posterior surgery involves atlantoaxial fixation with an indirect attempt to reduce and fuse the fracture. These are usually offered posterior transarticular screws (Magerl's) or posterior atlantoaxial screw rod/plate fixation (Goel-Harms technique).
Some of the fractures are not suitable for anterior odontoid screw (anterior oblique, displaced distal fragments and those with atlantoaxial instability…). A wide range of nonunion rates with immobilization alone (5–76%) is quoted: 30% is probably a reasonable estimate for overall nonunion rate, with 10% nonunion rate for those with displacement 4 mm increases nonunionī) some authors use ≥6 mm as the critical value, citing a 70%nonunion rate60 in these regardlessĪ) children 40 yrs (possibly ≈ doubling the nonunion rate),76 age >55 yrs,77 age >65 yrs,78 yet others do not support increasing age as a factor.Įstablishing a clear treatment paradigm for octogenarians hampered by a literature replete with level III articles.Ĭommon surgical option is an anterior odontoid screw. No agreement has been reached after many attempts to identify factors that will predict which type II fractures are most likely to heal with immobilization and which will require operative fusion.Ĭritical review of the literature reveals a paucity of well designed studies. Odontoid fracture type II treatment become increasingly common in the aging population.
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