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In vitro investigations of internal fixation systems of the upper cervical spine

I. Stability of the direct anterior screw fixation of the odontoid

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Résumé

Les fractures fraîches de l'odontoïde de type II et III et certains cas de pseudarthrose de l'odontoïde peuvent être réparés par une ostéosynthèse antérieure directe préservant la mobilité C1–C2. Le but de cette étude expérimentale était d'explorer la stabilité biomécanique permise par cette ostéosynthèse directe de l'odontoïde selon Böhler. 16 segments C1–C2 présentant des fractures de type II et III ont été testés in vitro dans des conditions bien définies. On a appliqué des moments de flexion et d'extension et des forces de cisaillement antérieur et postérieur et l'on a déterminé la mobilité du fragment odontoïdien refixé par rapport à C2. Les résultats ont montré que la fixation directe par vissage de l'odontoïde assure dans les conditions expérimentales une stabilité suffisante au fragment odontoïdien.

Summary

Fresh odontoid fractures of types II and III and in some cases nonunions of the odontoid can be repaired by direct anterior screw fixation preserving C1–C2 motion. The goal of this experimental study was to investigate the biomechanical stability of the fragment achieved by this direct odontoid osteosynthesis according to Böhler. Sixteen human C1–C2 segments with fractures of type II or type III were biomechanically tested in vitro under standardized conditions. Flexion and extension moments, anterior and posterior shear forces were applied, and the motion of the refixed odontoid fragment relative to C2 was determined. The results show that direct screw fixation of the odontoid under the experimental conditions provides sufficient stability for the dens fragment.

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Authors and Affiliations

  1. Department für Unfallchirurgische Forschung und Biomechanik, Universität Ulm, Helmholtzstrasse 14, W-7900, Ulm, Federal Republic of Germany

    H. -J. Wilke, K. Fischer, A. Kugler & L. Claes

  2. Klinik für Orthopädische Chirurgie, Kantonsspital St. Gallen, CH-9007, St. Gallen, Switzerland

    F. Magerl

  3. Stäctisches Krankenhaus, Orthopädisch-Unfallchirurgische Abteilung, Pacellistrasse 4, W-6400, Fulda, Federal Republic of Germany

    O. Wörsdörfer

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  1. H. -J. Wilke
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  2. K. Fischer
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  3. A. Kugler
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  4. F. Magerl
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  5. L. Claes
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  6. O. Wörsdörfer
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Wilke, H.J., Fischer, K., Kugler, A. et al. In vitro investigations of internal fixation systems of the upper cervical spine. Eur Spine J 1, 185–190 (1992). https://doi.org/10.1007/BF00301311

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