Clinical Orthopaedics and Related Research®

, Volume 470, Issue 7, pp 2021–2028

One-Screw Fixation Provides Similar Stability to That of Two-Screw Fixation for Type II Dens Fractures

  • Gang Feng
  • Robert Wendlandt
  • Sebastian Spuck
  • Arndt P. Schulz
Basic Research



Anterior screw fixation has been widely adopted for the treatment of Type II dens fractures. However, there is still controversy regarding whether one- or two-screw fixation is more appropriate.


We addressed three questions: (1) Do one- and two-screw fixation techniques differ regarding shear stiffness and rotational stiffness? (2) Can shear stiffness and rotational stiffness after screw fixation be restored to normal? (3) Does stiffness after screw fixation correlate with bone mineral density (BMD)?


We randomly assigned 14 fresh axes into two groups (seven axes each): one receiving one-screw fixation and another receiving two-screw fixation. Shear and torsional stiffness were measured using a nondestructive low-load test in six directions. A transverse osteotomy then was created at the base of the dens and fixed using one or two screws. Shear and torsional stiffness were tested again under the same testing conditions.


Mean stiffness in all directions after screw fixation was similar in both groups. The stiffness after one- and two-screw fixation was not restored to normal: the mean shear stiffness restored ratio was less than 50% and the mean torsional stiffness restored ratio was less than 6% in both groups. BMD did not correlate with mean stiffness after screw fixation in both groups.


One- and two-screw fixation for Type II dens fractures provide similar stability but neither restores normal shear or torsional stiffness.

Clinical Relevance

One-screw fixation might be used as an alternative to two-screw fixation. Assumed BMD should not influence surgical decision making.


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Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Gang Feng
    • 1
  • Robert Wendlandt
    • 2
  • Sebastian Spuck
    • 3
  • Arndt P. Schulz
    • 4
  1. 1.Department of Orthopaedic Surgery2nd Affiliated Hospital of Zhejiang University College of MedicineHangzhouChina
  2. 2.Laboratory for BiomechanicsUniversity Hospital of Schleswig-HolsteinLübeckGermany
  3. 3.Department of NeurosurgeryUniversity Hospital of Schleswig-HolsteinLübeckGermany
  4. 4.Department of Trauma and Orthopaedic SurgeryUniversity Hospital of Schleswig-HolsteinLübeckGermany

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