Halo jacket in odontoid fractures type II and III.

The treatment of odontoid fractures remains controversial. The late results of 14 patients with Anderson D'Alonzo type II and III treated with halo jacket from 1995 to 1999 are presented. The fractures were reduced under image intensifier and stabilized by halo jacket. The immobilization period was 12 weeks. After 1 year, the fracture was roentgenologically consolidated in 12 out of 14 patients (85.7%), and all the patients were without neurological deficit. Nine patients (64.3%) were without subjective complaints, five had a reduced range of motion. Painful motion appeared in four patients (28.6%), and cervical stiffness was noted in five (35.7%). We recommend halo jacket for the treatment of most type II and III odontoid fractures which are unstable or displaced 6 mm and more, except for patients with tetraplegia. Fractures with minimal displacement and without neurological deficit were treated conservatively with rigid collars. In our institution, internal fixation was performed in selected cases. The presence of neurological deficit and the anatomic properties of the fracture site crucially influence the choice of treatment.

Operative treatment of avulsion fractures of the anterior superior iliac spine according to the tension band principle.

BACKGROUND: Avulsion fractures of the anterior superior iliac spine are uncommon injuries. Most of them occur in adolescent athletes. Traditionally, they have been treated conservatively. We describe operative treatment of avulsion fractures that might shorten the period of rehabilitation. METHODS AND RESULTS: Six patients with avulsion fractures of the anterior superior iliac spine were treated operatively by open reduction and osteosynthesis with two Kirschner wires and a wire loop. After 6 weeks, all of them had resumed their sports activities. No complications were recorded. CONCLUSIONS: Operative treatment of anterior superior iliac spine avulsions may reduce the time to full recovery. It should be considered for athletes requiring a short period of rehabilitation.