scholarly journals Morphometric parameters of the odontoid process of C2 vertebrae, in Indian population, a CT evaluation

2021 ◽  
Vol 12 ◽  
pp. 494
Author(s):  
Shankar Acharya ◽  
Manoj Kumar ◽  
Jay Deep Ghosh ◽  
Nitin Adsul ◽  
R. S. Chahal ◽  
...  
Keyword(s):  
Indian Population ◽  
Odontoid Process ◽  
Morphometric Parameters ◽  
Transverse Diameter ◽  
Type Ii ◽  
Normal Anatomy ◽  
Odontoid Fractures ◽  
Screw Insertion ◽  
Ct Evaluation ◽  
The Mean

Background: Osteosynthesis of odontoid fractures, especially for type II odontoid fractures, is often achieved by the placement of screws. Here, utilizing CT, we evaluated the normal anatomy of the odontoid process in an Indian population to determine whether one or two screws could be anatomically accommodated to achieve fixation. Methods: CT-based morphometric parameters of the odontoid process were assessed in 200 normal Indian patients (2018–2020). Results: Of 200 patients, 127 were male, and 73 were female. The mean minimum external transverse diameter (METD) was 8.80 mm (range 6.1–11.9 mm). Six (3%) patients had a minimum internal transverse diameter (TD) of >8.0 mm that would allow for the insertion of two 3.5-mm cortical screws without tapping, while 10 (5%) patients had TDs of <7.4 mm; none had diameters of <5.5 mm. The mean length of the implant was 36.45 mm in females and 36.89 mm in males, and the mean angle of screw insertion was 60.34° in females and 60.53° in males. Conclusion: About two-thirds (59%) of the 200 subjects in our study had a METD of <9 mm, indicating the impracticality for introducing second screws for odontoid fixation.

Anterior fixation of odontoid fractures in an elderly population

2010 ◽  
Vol 12 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Andrew T. Dailey ◽  
David Hart ◽  
Michael A. Finn ◽  
Meic H. Schmidt ◽  
Ronald I. Apfelbaum
Keyword(s):  
Elderly Population ◽  
Odontoid Process ◽  
Feeding Tube ◽  
Type Ii ◽  
Single Institution ◽  
Odontoid Fractures ◽  
Single Screw ◽  
Flexion Extension ◽  
Fracture Nonunion

Object Fractures of the odontoid process are the most common fractures of the cervical spine in patients over the age of 70 years. The incidence of fracture nonunion in this population has been estimated to be 20-fold greater than that in patients under the age of 50 years if surgical stabilization is not used. Anterior and posterior approaches have both been advocated, with excellent results reported, but surgeons should understand the drawbacks of the various techniques before employing them in clinical practice. Methods A retrospective review was undertaken to identify patients who had direct fixation of an odontoid fracture at a single institution from 1991 to 2006. Patients were followed up using flexion-extension radiographs, and stability was evaluated as bone union, fibrous union, or nonunion. Patients with bone or fibrous union were classified as stable. In addition, the incidence of procedure- and nonprocedure-related complications was extracted from the medical record. Results Of the 57 patients over age 70 who underwent placement of an odontoid screw, 42 underwent follow-up from 3 to 62 months (mean 15 months). Stability was confirmed in 81% of these patients. In patients with fixation using 2 screws, 96% demonstrated stability on radiographs at final follow-up. Only 56% of patients with fixation using a single screw demonstrated stability on radiographs. In the immediate postoperative period, 25% of patients required a feeding tube and 19% had aspiration pneumonia that required antibiotic treatment. Conclusions Direct fixation of Type II odontoid fractures showed stability rates > 80% in this challenging population. Significantly higher stabilization rates were achieved when 2 screws were placed. The anterior approach was associated with a relatively high dysphagia rate, and patients must be counseled about this risk before surgery.

Biomechanical evaluation of a bioresorbable odontoid screw

2005 ◽  
Vol 2 (2) ◽  
pp. 182-187 ◽  
Author(s):  
Christopher P. Ames ◽  
Neil R. Crawford ◽  
Robert H. Chamberlain ◽  
Vivek Deshmukh ◽  
Belma Sadikovic ◽  
...  
Keyword(s):  
Ultimate Strength ◽  
Odontoid Process ◽  
Type Ii ◽  
Content Type ◽  
Odontoid Fractures ◽  
Titanium Screws ◽  
Piston Displacement ◽  
Initial Fracture ◽  
Strength And Stiffness ◽  
Fine Print

Object. The authors tested the ability of a resorbable cannulated lag screw composed of a polylactide copolymer to repair Type II odontoid fractures. The resorbable screw was evaluated for its ability to restore strength and stiffness to the fractured odontoid process compared with traditional titanium screws. Methods. Type II odontoid fractures were created in 14 human cadaveric C-2 vertebrae by applying a posterolaterally directed load and piston displacement was measured. Seven of these specimens were repaired using metal screws and seven were repaired using resorbable screws. Specimens were reinjured using the same mechanism as the initial fracture. Values of ultimate strength and stiffness during failure were statistically compared between metal and resorbable screws and between initial fracture and reinjury. Conclusions. The stiffness and ultimate strength during initial fracture were significantly greater than those during reinjury in specimens repaired using resorbable screws or titanium screws (p < 0.001). The resorbable and titanium screws both restored 31% of the initial ultimate strength of the intact specimen (p = 0.95). The stiffness of the fractured odontoid process was restored to 15 and 23% of its initial value by repair with resorbable and metal screws, respectively (p = 0.07). The mode of failure in resorbable screws was usually breakage or bending, whereas that in metal screws was consistently cutout of the proximal shaft of the screw through the anterior C-2 vertebral body.

scholarly journals MORPHOMETRIC ANALYSIS OF FORAMEN MAGNUM IN NORTH INDIAN POPULATION

2018 ◽  
Vol 26 (2) ◽  
Author(s):  
Poonam Srivastava ◽  
Medha Das ◽  
Shirin Jahan
Keyword(s):  
Morphometric Analysis ◽  
Indian Population ◽  
Uttar Pradesh ◽  
Foramen Magnum ◽  
Transverse Diameter ◽  
Brain Herniation ◽  
Medical College ◽  
The Mean ◽  
Large Opening ◽  
Human Skulls

Introduction: Foramen magnum is a large opening located in the occipital bone of the skull. The morphometric analysis of foramen magnum is clinically and surgically important because vital structures passing through it may suffer compression such as in cases of achondroplasia, brain herniation and meningiomas. Objectives: To study morphometric analysis of foramen magnum in dry human skulls and to measure its anteroposterior diameter, transverse diameter and foramen magnum index. Material & Methods: 100 dried human skulls of unknown age and sex were obtained from Department of Anatomy, Rama Medical College and GSVM Medical College, Kanpur, Uttar Pradesh, India. Deformed samples were excluded. Different parameters were measured with the help of Vernier caliper. Results: The mean antero-posterior diameter of foramen magnum was 33.79mm. The maximum antero-posterior diameter of foramen magnum was 40mm and minimum antero-posterior diameter was 28.2mm.The mean transverse diameter of foramen magnum was 28.30mm.The maximum transverse diameter of foramen magnum was 36mm and minimum transverse diameter was 21.5mm.The mean index of foramen magnum was 84.14mm. Conclusion: The morphometric analysis of foramen magnum and its variation is important not only for anatomists but also important to the anesthetists, neurosurgeons, orthopedicians and radiologists ; while planning and performing cranio-vertebral junction procedures.

scholarly journals Morphometric study of acromion process in scapula of north Indian population

2017 ◽  
Vol 5 (11) ◽  
pp. 4965 ◽  
Author(s):  
Ritu Singroha ◽  
Usha Verma ◽  
Preeti Malik ◽  
Suresh Kanta Rathee
Keyword(s):  
Indian Population ◽  
Morphometric Parameters ◽  
Impingement Syndrome ◽  
Morphometric Study ◽  
Type Ii ◽  
North Indian Population ◽  
Significant Difference ◽  
Length Width ◽  
Males And Females

Background: In scapula, the acromion process projects forwards almost at right angle from the lateral end of spine. Morphometry of the acromion process is an important factor in contributing to impingement syndrome of the shoulder joint.Methods: The study was performed at Department of Anatomy, PGIMS Rohtak on 50 pairs of human scapula, out of which 30 were males and 20 were females. The various parameters like length, width, thickness, coraco-acromial distance, acromio-glenoid distance and types of acromion process were recorded using vernier calipers. These parameters were compared in both sexes on both the sides.Results: Type-II Acromion i.e. Curved type was found to be most predominant. Statistically significant difference was noted in all the five parameters between males and females except Acromio-glenoid distance on right side.Conclusions: Knowledge of the morphometric parameters of acromion process is important for Orthopaedicians, Anthropologists and Anatomists.

SURGICAL MANAGEMENT OF ODONTOID FRACTURES, AN INSTITUTIONAL EXPERIENCE.

2021 ◽  
pp. 45-47
Author(s):  
B.D. B.S. Naik ◽  
M.V. Vijayasekhar ◽  
P Prahaladhu ◽  
K Satyavaraprasad ◽  
Nikhil Tadwalkar
Keyword(s):  
Cervical Spine ◽  
Odontoid Process ◽  
Odontoid Fracture ◽  
Common Mechanism ◽  
Type I ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Transoral Odontoidectomy ◽  
King George Hospital ◽  
A Prospective Study

Introduction- Odontoid fractures occur as a result of high impact trauma to the cervical spine. Hyperextension of the cervical spine is The most common mechanism of injury. Odontoid fractures occurs in 10 to 15% of all cervical spine fractures . Fracture of the odontoid process is classied into one of three types which are type I, type II, or type III fractures. Of all the types of odontoid fractures, type II is the most common and accounts for over 50% of all odontoid fractures . Materials and Methods- This is a prospective study conducted over 2 years in Neurosurgery Department, Andhra Medical College & King George Hospital, Visakhapatnam. Result: A total of 18 odontoid fractures were managed in the period of two years, out of which 2 were kept conservative and 16 were operated. Out of 16, 11were operated with odontoid screw and 2 underwent C1-C2 xation and 3 patients underwent Transoral Odontoidectomy with posterior occipito-cervical xation Conclusion: The treatment of odontoid fracture is complex and should be planned according to the type of odontoid fracture and neurological decit. Odontoid screw will sufce in patients with type II fracture with undisplaced fragments. Posterior C1-C2 xation is a better choice for complex odontoid fractures. Transoral odontoidectomy and occipito-cervical xation is reserved as the last option.

Anterior Screw Fixation of Posteriorly Displaced Type II Odontoid Fractures

Neurosurgery ◽  
1989 ◽  
Vol 25 (1) ◽  
pp. 30-38 ◽  
Author(s):  
Fred H. Geisler ◽  
Charles Cheng ◽  
Attila Poka ◽  
Robert J. Brumback
Keyword(s):  
Structural Integrity ◽  
Screw Fixation ◽  
Odontoid Process ◽  
Cervical Vertebra ◽  
High Rate ◽  
Posterior Arch ◽  
Treatment Technique ◽  
Type Ii ◽  
Fracture Union ◽  
Odontoid Fractures

Abstract Posteriorly displaced Type II odontoid fractures (Type II-P) are difficult to stabilize in an anatomic position with accepted methods of posterior atlantoaxial arthrodesis. Nine patients with Type II-P odontoid fractures with 4 to 15 mm displacement were treated with anterior odontoid screw stabilization. Seven of these patients had associated fractures or defects of the posterior arch of the first cervical vertebra (C1). Atlantoaxial posterior arthrodesis in these patients would not have been possible initially because of the lack of structural integrity of the posterior arch of C1. Two patients, later in the study, had no injury to the ring of C1. The odontoid fractures were stabilized with two 4.0-mm cancellous screws inserted through an anterior approach to the neck under fluoroscopic control with the skin incision at the C5 level. Preoperative reduction of the displaced odontoid process and immediate operative stability of the atlantoaxial complex were obtained in each case. No neurological complications related to the procedure occurred. Two patients died of causes unrelated to their cervical fracture surgery. The 7 patients who survived were followed for a minimum of 6 months. Fracture union and cervical stability were demonstrated in each of the surviving patients, without evidence of screw loosening or loss of fixation. Normal range of motion of the neck was documented at follow-up in all surviving patients. Although this series represents a limited experience with this treatment technique, anterior odontoid screw fixation has significant advantages over accepted methods of cervical stabilization for Type II-P odontoid fractures. Immediate cervical stabilization is obtained, with a predictably high rate of fracture union and preservation of atlantoaxial motion. We believe this technique to be the treatment method of choice for Type II-P odontoid fractures displaced 4 mm or more accompanied by fractures of the posterior arch of the first cervical vertebra.

scholarly journals Evaluation of external stabilization of type II odontoid fractures in geriatric patients—An experimental study on a newly developed cadaveric trauma model

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260414
Author(s):  
Matthias K. Jung ◽  
Gregor V. R. von Ehrlich-Treuenstätt ◽  
Andreas L. Jung ◽  
Holger Keil ◽  
Paul A. Grützner ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Geriatric Patients ◽  
Odontoid Fracture ◽  
Cervical Collar ◽  
Type Ii ◽  
Lateral Bending ◽  
Odontoid Fractures ◽  
Human Cadavers ◽  
The Mean ◽  
External Stabilization

Background Along with the growing geriatric population, the number of odontoid fractures is steadily increasing. However, the effectiveness of immobilizing geriatric odontoid fractures using a cervical collar has been questioned. The aim of the present study is to analyze the physiological and pathological motion in odontoid fractures and to assess limitation of motion in the cervical spine when applying a cervical collar. Methods Motion analysis was performed with wireless motion tracker on unfixed geriatric human cadavers. First, a new geriatric type II odontoid fracture model was developed. In this model, the type II odontoid fracture is operated via a transoral approach. The physiological and pathological flexion and lateral bending of the cervical spine resulting from this procedure was measured. The resulting motion after external stabilization using a cervical collar was analyzed. Results The new geriatric type II odontoid fracture model was successfully established using seven unfixed human cadavers. The pathological flexion of the cervical spine was significantly increased compared to the physiological flexion (p = 0.027). Furthermore, the flexion was significantly reduced when a cervical collar was applied. In case of flexion the mean remaining motion was significantly reduced (p = 0.0017) from 41° to 14°. For lateral bending the mean remaining motion was significantly reduced (p = 0.0137) from 48° to 18°. Conclusions In case of type II odontoid fracture, flexion and lateral bending of the cervical spine are increased due to spinal instability. Thus, if an odontoid fracture is suspected in geriatric patients, the application of a cervical collar should always be considered since external stabilization can significantly reduce flexion and lateral bending.

scholarly journals One-year follow-up for type II odontoid process fractures in octogenarians: Is there a place for surgical management?

2020 ◽  
Vol 11 ◽  
pp. 285
Author(s):  
Francois Borsotti ◽  
Daniele Starnoni ◽  
Timo Ecker ◽  
Juan Barges Coll
Keyword(s):  
Surgical Management ◽  
Injury Severity ◽  
Odontoid Process ◽  
Group Versus ◽  
Mortality Rates ◽  
Magnetic Resonance Images ◽  
X Rays ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Computed Tomography Images

Background: Type II odontoid fractures are becoming one of the most common injuries among elderly patients and are associated with increased morbidity rates. Here, we compared the safety/efficacy of conservative versus surgical treatment for type II C2 fractures and, in particular, evaluated the complications, hospital lengths of stay, and mortality rates for patients over 80 years of age. Methods: We retrospectively reviewed the records of 63 nonsurgically versus 18 surgically treated C2 fractures in patients over 80 years of age (2003–2018). Cervical computed tomography images, X-rays, and magnetic resonance images were reviewed by both a neurosurgeon and a neuroradiologist. The following patient data were included in the analysis; Glasgow Coma Scale score, injury severity score, the abbreviated injury scale scores, their comorbidities (e.g., utilizing the Charlson comorbidity index), their primary outcomes, and mortality rates (e.g., at 6 weeks and 1 year after treatment). Results: Eighty-one patients were included in the study; 63 were treated conservatively and 18 underwent surgical management of type II C2 fractures. Patients averaged 87.0 ± 5.0 years of age, and their combined mortality rates were 13.6% at 6 weeks and 25.9% at 1 year. Notably, at 1 year, the mortality rates were not statistically different between the two groups: 18 (30.0%) patients from the conservatively treated group versus 3 (16.7%) patients from the surgically managed patients died indicating (e.g., using the Kaplan–Meier analysis) no survival advantage for either treatment strategy. Conclusion: Surgical versus conservative management of type II odontoid fractures were associated with comparable high mortality rates at 1 year.

Biomechanical evaluation of 2 insertion points for ventral screw fixation of C-2 dens fractures

2013 ◽  
Vol 18 (6) ◽  
pp. 553-557 ◽  
Author(s):  
Ludwig Oberkircher ◽  
Christopher Bliemel ◽  
Felix Flossdorf ◽  
Tim Schwarting ◽  
Steffen Ruchholtz ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Mechanical Stability ◽  
Screw Fixation ◽  
Primary Stability ◽  
Anterior Wall ◽  
Type Ii ◽  
Screw Insertion ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Object For many Type II fractures of the dens (Anderson and D'Alonzo classification), a double anterior screw fixation is performed. If screw disruption occurs, the location is most often at the anterior caudal endplate and body of the axis and not directly at the fracture line. The authors' objective was to determine the differences in primary mechanical stability at 2 insertion points used in ventral screw fixation of Type II fractures of the C-2 dens. Methods Screw fixation was performed on 16 formalin-fixed human C-2 dens specimens. The specimens were divided into 2 groups. For Group 1, the screws were inserted directly at the anterior lower endplates; for Group 2, the screws were inserted 2 mm dorsal to the anterior wall of the vertebral body. After a Type II odontoid fracture was created with an oscillating saw, screw fixation was performed using two 3.5-mm partially threaded lag screws with washers. Subsequently, each vertebral body was continuously loaded. The criterion for breakage was reversal of the force vector. Results In Group 1, screw disruption occurred at the point of entry; the mean load failure was 290.5 ± 106 N. In Group 2, no screw disruption occurred; the mean load failure was 574.2 ± 170.5 N. These results were significant (p < 0.05). Conclusions For double screw fixation of Type II fractures of the dens (Anderson and D'Alonzo classification), placement of the screws as far dorsal to the anterior lower endplate as possible seems to favorably affect primary stability. In actual clinical practice, care should be taken to not damage the anterior wall of the vertebral body of the axis during screw insertion.

scholarly journals Morphology and morphometry of infra orbital foramen in South Indian adult dry skulls

2014 ◽  
Vol 03 (03) ◽  
pp. 122-127
Author(s):  
Vishal K. ◽  
Vinay K V. ◽  
Johncy I P.
Keyword(s):  
Regional Variation ◽  
Indian Population ◽  
Transverse Diameter ◽  
South Indian Population ◽  
Morphometric Data ◽  
Orbital Margin ◽  
South Indian ◽  
Horizontal Diameter ◽  
The Mean ◽  
Morphology And Morphometry

Abstract Background: The infra orbital foramen (IOF) situated below infra-orbital margin (IOM) transmits infra­orbital nerve and infra- orbital vessels. The knowledge of the dimension, shape and direction of the IOF has important implications in various surgical and anaesthetic procedures. This will avoid iatrogenic injury to neurovascular bundle emerging from the IOF. Material and methods: Sixty adult dry skulls of unknown sex from the Department of Anatomy and Department of Forensic Medicine were used. IOF on both sides of skulls were assessed for the shape and direction by inspection. The vertical and horizontal diameter of the IOF was measured using a digital Vernier caliper to the nearest millimeters and the results were statistically analyzed. Results: The shape of the IOF was vertically oval in majority of the skulls (37.5%) and was semi lunar shaped in 10.83% of the skull. The IOF was directed infero­medially in about 52.5% of the cases and was directed medially in 6.67% of the cases. The mean transverse diameter was 2.96mm and the mean vertical diameter was 3.7mm. All the above results were compared with studies of previous workers. Conclusion: The present study confirms that there is racial as well as regional variation in the shape and dimensions of IOF, thus emphasizing the need to have morphometric data for South Indian population.

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