Abstract
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.
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References
Anderson LD, D'Alonzo RT (1974) Fractures of the odontoid process of the axis. J Bone Joint Surg Am 56:1663–1674
Apfelbaum RI, Lonser RR, Veres R, Casey A (2000) Direct anterior screw fixation for recent and remote odontoid fractures. Neurosurg Focus 8: article 2 [JNS:Spine Preview, October 2000]
Berlemann V, Schwarzenbach O (1997) Dens fractures in the elderly. Acta Orthop Scand 68:319–324
Blauth M (1998) Obere Halswirbelsäule. In: Tscherne H, Blauth M (eds) Wirbelsäule. Springer, Berlin Heidelberg New York, pp 88–99
Chiba K, Fujimura Y, Toyama Y, et al (1996) Treatment protocol for fractures of the odontoid process. J Spinal Disord 9:267–276
Coyne TJ, Fehlings MG, Wallace MC, Bernstein M, Tator CH (1995) C1-C2 posterior cervical fusion: long-term evaluation of results and efficacy. Neurosurgery 37:688–692
Dunn ME, Seljeskog EL (1986) Experience in the management of odontoid process injuries: an analysis of 128 cases. Neurosurgery 18:306–310
Greenberg MS (1994) Spine injuries. In: Greenberg MS (ed) Handbook of neurosurgery, 3rd edn. Greenberg Graphics, Lokeland, FL, pp 586–588
Greene KA, Dickman CA, Marciano FF, et al (1997) Acute axis fractures. Analysis of management and outcome in 340 consecutive cases. Spine 22:1843–1852
Harrop JS, Przybylski GJ, Vaccaro AR, Yalamanchili K (2000) Efficacy of anterior odontoid screw fixation in elderly patients with type II odontoid fractures. Neurosurg Focus 6: article 6
Hart R, Saterbak A, Rapp T, Clark C (2000) Nonoperative management of dens fracture nonunion in elderly patients without myelopathy. Spine 25:1339–1343
Henry AD, Bohly J, Grosse A (1999) Fixation of odontoid fractures by anterior screw. J Bone Joint Surg Br 81:472–477
Julien TD, Frankel B, Traynelis VC, Ryken TC (2000) Evidence-based analysis of odontoid fracture management. Neurosurg Focus 6: article 1
Komadina R (1999) Osteoporotic fractures. Slovenian Society of Trauma Surgeons, pp 21–30
Kuner E, Schlosser V (1988) Verletzungen der Wirbelsäule. In: Kuner E, Schlosser V (eds) Traumatologie, 4th edn. Thieme, Stuttgart, pp 286–322
Lennarson PJ, Mostafavi H, Traynelis VC, Walters BC (2000) Management of type II dens fractures. Spine 25:1234–1237
Marchesi DG (1997) Management of odontoid fractures. Orthopaedics 20:911–916
Polin RS, Szabo T, Bogaev CA, et al (1996) Nonoperative management of types II and III odontoid fractures: the Philadelphia collar versus the halo vest. Neurosurgery 38:450–457
Raber D, Munich T, Morscher E (1996) Spinal pseudoarthrosis. Orthopade 25:435–440
Rusek R, Komadina R, Pilih R (1990) Atlantooccipital luxation. Zdrav Vestn 313–314
Seybold EA, Bayley JC (1998) Functional outcome of surgically and conservatively managed dens fractures. Spine 23:1837–1846
Stoney J, O'Brien J, Wilde P (1998) Treatment of type two odontoid fractures in halothoracic vests. J Bone Joint Surg Br 80:452–455
Subach BR, Morone MA, Haid RW, McLaughlin MR, Rodts GR, Comey CH (2000) Management of acute odontoid fractures with single-screw anterior fixation. Neurosurgery 45:812–819
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Komadina, R., Brilej, D., Kosanović, M. et al. Halo jacket in odontoid fractures type II and III. Arch Orthop Trauma Surg 123, 64–67 (2003). https://doi.org/10.1007/s00402-003-0473-4
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DOI: https://doi.org/10.1007/s00402-003-0473-4