Clinical Evaluation of Direct Anterior Screw Fixation of Odontoid Fractures

ABSTRACT

dontoid fractures have been treated either conservatively or by surgical fixation, and whether one method is better than the other is still controversial. Because it more effectively overcomes the problems of fracture instability and nonuinon, operative stabilization is now favored over external immobilization for the treatment of Type IIodontoid fractures. Most surgical stabilizations of such fractures use posterior cervical wiring techniques with C1-C2 arthrodesis; these, however, obliterate the rotation and flexion/extension of the atlantoaxial complex,and in Type II-P fractures, provide little resistance to further posterior subluxation. As no arthrodesis is performed, direct anterior screw fixation of odontoid fractures theoretically stabilizes the atlantoaxial complex and preserves its motion. Between January 1993 and December 1996, we performed eleven anterior screw fixations in patients who had suffered odontoid fractures(Type II, III); these were postoperatively followed up for an average of 27 months. Excepet for two cases of permissible malunion, thought to be due to fixation on a partially reduced state, all eleven cases showed firm union at the fracture site, with no significant disabilities and complications. The results indicate that in odontoid fracture reduction and eventual fracture union, the outcome of anterior screw fixation is excellent; there is, in addition, no decrease in cervical motion, a disadvantage inherent in currently accepted methods of treatment.