![]() Surgical treatment is indicated in patients with unstable fractures. The reported union rates of surgical treatment ranged from 88 to 100%. The reported union rate for type II fractures treated with immobilization in either a halo vest or a sternal occipital mandibular immobilizer brace was 76%. The difficulty is to determine how such immobilization should be achieved and maintained: collar immobilization halo immobilization, anterior or posterior internal fixation. To acquire fracture union, immobilization is essential for these fractures. The treatment of type II odontoid fractures remains controversial since the nonunion rate is high for type II fractures, and the risk factors have been suggested. The treatment varies from conservative treatment with brace or halo-vest to a variety of surgical treatments. Atlanto-axial instability is common in type II odontoid fractures, and the treatment can be difficult. The common injury mechanism typically consists of high falls or traffic accidents. Fractures of the dens comprise 18 to 20% of cervical injuries, of which 65 to 74% are Anderson-D’Alonzo type II fractures. Odontoid fractures are classified into three types according to fracture location in the sagittal plane (I, II, or III). Posterior instrumentation without fusion could preserve most of the atlanto-axial rotary function and lead to moderate neck discomfort and is also a good alternative if anterior screw fixation is contraindicated. For most fresh type II odontoid fractures, anterior screw fixation was the best option for its simplicity and preservation of normal atlanto-axial rotary function. Conclusionsįor fresh type II odontoid fractures, high rate of fracture union can be achieved by both ACSF and PIWF. Both groups had a case of fracture non-union. The fusion rates were 90.9 and 96% respectively in ACSF and PIWF. The NDI in PIWF was statistically higher than that in ACSF (5 and 13% respectively in ACSF and PIWF) after the first operation and decreased to 8% 1 year after the secondary operation. The average range of neck rotation was dramatically lost in PIWF after fixation (46° and 89° respectively in ACSF and PIWF), and recovered to 83° after the implant was removed. The follow-up periods ranged from 24 to 60 months. ResultsĪll patients achieved immediate spinal stabilization after surgery, and none experienced neurologic deterioration. All fractures were reassessed postoperatively with serial X-films and CT scans of the cervical spine at each follow-up visit, to evaluate screw position, fracture alignment, and fusion status. The range of rotary motion was evaluated at each visit. The neck disability index (NDI) was used to assess the neck discomfort caused by the operation. All patients underwent preoperative and serial postoperative clinical examinations at approximately 3 months, 6 months, and annually thereafter. For PIWF, the implants were removed after fracture union was confirmed at 0.75~1.5 years later. Eleven patients were treated with ACSF, and 25 patients with PIWF. This series included 28 males and 8 females, and the mean age was 41.5 years (range, 22 to 70 years). ![]() The objective of this study is to compare the clinical outcome of two treatments of fresh type II odontoid fracture: anterior cannulated screws fixation (ACSF) versus posterior instrumentation of C1-2 without fusion (PIWF). It is still unclear if this technique could achieve the equivalent outcomes as the golden standard technique of anterior screw fixation. ![]() Recently, the excellent outcomes of temporary fixation of C1-2 without fusion in the treatment of odontoid fracture had been reported.
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