Unstable odontoid fractures: technical appraisal of anterior extrapharyangeal open reduction internal fixation for irreducible unstable odontoid fractures. Patient series

BACKGROUND Displaced odontoid fractures that are irreducible with traction and have cervicomedullary compression by the displaced distal fracture fragment or deformity caused by facetal malalignment require early realignment and stabilization. Realignment with ultimate solid fracture fusion and atlantoaxial joint fusion, in some situations, are the aims of surgery. Fifteen such patients were treated with direct anterior extrapharyngeal open reduction and realignment of displaced fracture fragments with realignment of the atlantoaxial facets, followed by a variable screw placement (VSP) plate in compression mode across the fracture or anterior atlantoaxial fixation (transarticular screws or atlantoaxial plate screw construct) or both. OBSERVATIONS Anatomical realignment with rigid fixation was achieved in all patients. Fracture fusion without implant failure was observed in 100% of the patients at 6 months, with 1 unrelated mortality. Minimum follow-up has been 6 months in 14 patients and a maximum of 3 years in 4 patients, with 1 unrelated mortality. LESSONS Most irreducible unstable odontoid fractures can be anatomically realigned by anterior extrapharyngeal approach by facet joint manipulation. Plate (VSP) and screws permit rigid fixation in compression mode with 100% fusion. Any associated atlantoaxial instability can be treated from the same exposure.

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Use of a titanium mesh cage for posterior atlantoaxial arthrodesis

Journal of Neurosurgery Spine ◽

10.3171/spi.2002.96.1.0127 ◽

2002 ◽

Vol 96 (1) ◽

pp. 127-130 ◽

Cited By ~ 4

Author(s):

Morio Matsumoto ◽

Kazuhiro Chiba ◽

Takashi Tsuji ◽

Hirofumi Maruiwa ◽

Yoshiaki Toyama ◽

...

Keyword(s):

Donor Site ◽

Atlantoaxial Instability ◽

Os Odontoideum ◽

Posterior Arch ◽

Rigid Fixation ◽

Titanium Mesh ◽

Content Type ◽

Atlantoaxial Fixation ◽

Mesh Cage ◽

Atlantoaxial Arthrodesis

✓ The authors placed titanium mesh cages to achieve posterior atlantoaxial fixation in five patients with atlantoaxial instability caused by rheumatoid arthritis or os odontoideum. A mesh cage packed with autologous cancellous bone was placed between the C-1 posterior arch and the C-2 lamina and was tightly connected with titanium wires. Combined with the use of transarticular screws, this procedure provided very rigid fixation. Solid fusion was achieved in all patients without major complications. The advantages of this method include more stable fixation, better control of the atlantoaxial fixation angle, and reduced donor-site morbidity compared with a conventional atlantoaxial arthrodesis in which an autologous iliac crest graft is used.

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Occipital Condyle Fracture: A Case Report of a Typically Stable Fracture That Required Surgical Treatment

Case Reports in Orthopedics ◽

10.1155/2018/2809546 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Takeshi Suzuki ◽

Satoshi Maki ◽

Masaaki Aramomi ◽

Tomonori Yamauchi ◽

Manato Horii ◽

...

Keyword(s):

Computed Tomography ◽

Surgical Treatment ◽

Facet Joint ◽

Atlantoaxial Instability ◽

Occipital Condyle ◽

Asian Woman ◽

Atlantoaxial Joint ◽

Occipitocervical Fusion ◽

Occipital Condyle Fracture ◽

Condyle Fracture

An occipital condyle fracture (OCF) is a relatively rare trauma that is now increasingly diagnosed because of the wide availability of computed tomography. For nondisplaced OCFs, conservative treatment is generally recommended, and there is no previous report of a nondisplaced OCF requiring surgery. We report a patient who had a nondisplaced OCF with craniocervical misalignment (a condyle-C1 interval > 2.0 mm) and C1-C2 translation treated with a halo vest and occipitocervical fusion surgery. An 87-year-old Asian woman fell from a 4-meter height and hit her head. She was transferred to our emergency room. Computed tomography revealed a nondisplaced impaction OCF with a 2.5 mm occipital condyle-C1 interval and a 5 mm C1-C2 translation. The fracture pattern was considered stable. However, since craniocervical misalignment and C1-C2 translation were present, the patient was placed in a halo device, and we reduced the occipitoatlantoaxial joint, adjusting the halo ring position preoperatively. Confirming reduction of the atlantooccipital facet joint and the atlantoaxial joint by computed tomography, we performed an occipitocervical fusion. This is the first report of a nondisplaced OCF with craniocervical misalignment and C1-C2 translation that required surgical treatment. Clinicians should be aware of craniocervical misalignment and atlantoaxial instability even in Tuli type 1 OCFs.

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PLATE FIXATION OF ODONTOID FRACTURES WITHOUT C1–C2 ARTHRODESIS

Neurosurgery ◽

10.1227/01.neu.0000339117.60613.8c ◽

2009 ◽

Vol 64 (4) ◽

pp. 726-733 ◽

Cited By ~ 7

Author(s):

Patrick Platzer ◽

Gerhild Thalhammer ◽

Anna Krumboeck ◽

Rupert Schuster ◽

Florian Kutscha-Lissberg ◽

...

Keyword(s):

Surgical Treatment ◽

Plate Fixation ◽

Activity Level ◽

Rigid Fixation ◽

Atlantoaxial Joint ◽

Anterior Plate ◽

Odontoid Fractures ◽

Patient Reported ◽

Pain Symptoms ◽

Fracture Compression

Abstract OBJECTIVE Surgical treatment of odontoid fractures that do not allow interfragmentary fracture compression involves either posterior atlantoaxial arthrodesis or additional anterior stabilization using a plate construct. The purpose of this study was to determine the clinical and radiographic outcome after anterior plate fixation of odontoid fractures that were not suitable for anterior screw fixation. METHODS We reviewed the clinical and radiographic records of 9 patients with an average age of 54 years at the time of surgery who had undergone anterior plate fixation of an odontoid fracture. Indications for using a plate construct were odontoid fractures with anterior oblique fracture lines, fractures with comminution or major displacement, and pathological fractures. RESULTS Eight patients returned to their preinjury activity level and were satisfied with their treatment. One patient reported chronic pain symptoms and a notable decrease in cervical spine motion. Using the Smiley-Webster Scale to quantify their clinical outcome, we achieved an overall outcome score of 1.6. Bony fusion was achieved in all patients. Reduction or fixation failed in 2 patients. Reoperation for technical failures was not necessary in any of the patients. CONCLUSION We had promising results using anterior plate fixation for surgical treatment of odontoid fractures that did not allow interfragmentary fracture compression. Because this method avoids the rigid fixation of the atlantoaxial joint in contrast to techniques of posterior cervical arthrodesis, it seems to be a practical option for the management of fracture types that require additional stabilization of the odontoid.

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Posterior atlantoaxial fixation with new subfacetal axis screw trajectory avoiding vertebral artery with customized variable screw placement plate and screws to enhance biomechanics of fixation

Neurosurgical Focus: Video ◽

10.3171/2020.4.focusvid.20168 ◽

2020 ◽

Vol 3 (1) ◽

pp. V10

Author(s):

Sushil Patkar

Keyword(s):

Vertebral Artery ◽

Facet Joint ◽

Articular Surface ◽

Standard Of Care ◽

Screw Placement ◽

Atlantoaxial Instability ◽

Technological Advances ◽

Atlantoaxial Fixation ◽

Screw Position ◽

Developed World

Fixation for atlantoaxial dislocation is a challenging issue, and posterior C1 lateral mass and C2 pars–pedicle screw plate–rod construct is the standard of care for atlantoaxial instability. However, vertebral artery injury remains a potential complication. Recent literature has focused on intraoperative navigation, the O-arm, 3D printing, and recently use of robots for perfecting the trajectory and screw position to avoid disastrous injury to the vertebral artery and enhance the rigidity of fixation. These technological advances increase the costs of the surgery and are available only in select centers in the developed world.Review of the axis bone anatomy and study of the stress lines caused by weight transmission reveal that the bone below the articular surface of the superior facet is consistently dense as it lies along the line of weight transmission A new trajectory for the axis screw 3–5 mm below the midpoint of the facet joint and directed downward and medially avoids the course of the vertebral artery and holds the axis rigidly. Divergent screw constructs are biomechanically stronger. Variable screw placement (VSP) plates with long shaft screws permit manipulation of the vertebrae and realignment of the facets to the correct reduced position with fixation in the compression mode.The video can be found here: https://youtu.be/E1msiKjM-aA

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Craniovertebral instability due to degenerative osteoarthritis of the atlantoaxial joints: analysis of the management of 108 cases

Journal of Neurosurgery Spine ◽

10.3171/2009.12.spine0999 ◽

2010 ◽

Vol 12 (6) ◽

pp. 592-601 ◽

Cited By ~ 58

Author(s):

Atul Goel ◽

Abhidha Shah ◽

Sanjay Rajan Gupta

Keyword(s):

Cord Compression ◽

Basilar Invagination ◽

Atlantoaxial Instability ◽

Atlantoaxial Joint ◽

Lateral Mass ◽

Tissue Mass ◽

Degenerative Osteoarthritis ◽

Joint Distraction ◽

Atlantoaxial Fixation ◽

Compression Treatment

Object The authors retrospectively analyzed a series of 108 patients in whom was diagnosed atlantoaxial instability due to degenerative osteoarthritis of the atlantoaxial joints. The management issues in such cases are discussed. Methods One hundred eight patients with osteoarthritis of the atlantoaxial joints and resultant craniovertebral instability—diagnosed on the basis of presenting clinical features, radiological imaging, and direct observation of the joint status during surgery—were retrospectively analyzed. Between 1990 and 2008, these patients were treated with a C1–2 lateral mass plate and screw method of atlantoaxial fixation and joint distraction using bone graft with or without the assistance of metal spacers. Results Patient ages ranged from 48 to 84 years (average 63 years). There was a history of mild to moderate head and/or neck trauma 2 months to 11 years prior to diagnosis in 40% of the cases. All patients had symptoms of neck pain, and 82% of the patients had progressive myelopathy. A reduction in the height of the atlantoaxial lateral mass complex (100%), mobile atlantoaxial dislocation (100%), basilar invagination (68%), and periodontoid degenerative tissue mass (90%) were the more frequently encountered radiological features. Two patients died in the immediate postoperative period. At an average follow-up of 64 months, all surviving patients remarkably improved to varying degrees in their neurological condition. Conclusions Atlantoaxial joint arthritis frequently leads to craniovertebral instability and cord compression. Treatment by joint distraction and lateral mass fixation can be an optimum form of treatment.

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Fracture of the Body's Hamate Bone: Open Reduction Internal Fixation by Double Approach—A Case Report

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0038-1654722 ◽

2018 ◽

Vol 46 (02) ◽

pp. 126-130

Author(s):

Jorge Salvador Marín ◽

Antonia Brotons Baile ◽

Nuria Cardona Vives ◽

Jaime Vargas Prieto ◽

José Pérez Alba ◽

...

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Open Reduction Internal Fixation ◽

The Body ◽

Kirschner Wires ◽

Double Approach ◽

Displaced Fracture ◽

Capitate Bone ◽

Type Of Fracture ◽

Dash Questionnaire

AbstractHamate fractures are rare. Their treatment depends on the displacement and type of fracture. We present the case and surgical technique of a 33-year-old male patient, who is a manual worker, with a displaced fracture of the body of the hamate bone associated with dislocation of the fourth and fifth metacarpal (MC) bones. The patient was operated on with a double palmar and dorsal approach directly over the hamate and the body hook, respectively, which was performed to improve the control reduction and avoid damaging the neighboring vascular and nerve structures. The open reduction internal fixation (ORIF) was performed by inserting mini-screws in a dorsal to palmar direction. Later, the dislocations were reduced and fixed with Kirschner wires between the fourth and fifth MC bases, and between the fourth MC base and the capitate bone. The patient was discharged 2.5 months after the fracture. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire outcome measure was 5 points at 6 months postsurgery.

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Basilar Invagination: Surgical Treatment by Novel Anterior Implant

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i06.2248 ◽

2021 ◽

Vol 11 (6) ◽

Author(s):

Sushil V Patkar ◽

Pradnya Patkar

Keyword(s):

Surgical Treatment ◽

Basilar Invagination ◽

Atlantoaxial Dislocation ◽

The Body ◽

Atlantoaxial Instability ◽

Rigid Fixation ◽

Titanium Plate ◽

X Ray ◽

Atlantoaxial Fixation ◽

Cost Efficient

Introduction: Anterior retropharyngeal realignment, distraction, and atlantoaxial fixation are an option for the treatment of symptomatic basilar invagination (BI). The anterior implants for distraction and fixation for atlantoaxial joints are still evolving. We share our experience using a novel implant which can easily, safely, and rigidly fix both lateral masses to the body of the axis. Methods: After exposing both the atlantoaxial joints anteriorly, the joints were prepared, distracted with wedge shaped autologous tricorticate bone grafts and realigned to correct the cervicomedullary strain. The atlantoaxial joints were fixed using a novel titanium plate by passing screws upwards and laterally into the lateral masses of the atlas and centrally into the body of the axis. Post-operative imaging showed effective correction of BI and atlantoaxial dislocation. Post-operative dynamic X-ray images confirmed maintenance of rigid fixation at 6 months. Conclusion: This new plate screw construct is safe, easy, cost-efficient, and biomechanically appealing option for the treatment of symptomatic BI. Keywords: Basilar invagination, atlantoaxial dislocation, vertebral artery injury, atlantoaxial fixation, atlantoaxial instability.

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C2 Translaminar Screw Fixation (Wright`s Technique) Applicability in Atlantoaxial Instability

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v23i2.1163 ◽

2018 ◽

Vol 23 (2) ◽

pp. 152-156

Author(s):

Lucas Alves Aurich ◽

Jerônimo Buzetti Milano ◽

Erasmo Barros Da Silva Júnior ◽

Ricardo Ramina

Keyword(s):

Screw Fixation ◽

Atlantoaxial Instability ◽

Rigid Fixation ◽

Fixation Technique ◽

Advantages And Disadvantages ◽

Risks And Benefits ◽

Translaminar Screw Fixation ◽

Translaminar Screw ◽

Fixation Techniques ◽

Atlantoaxial Fixation

Atlantoaxial instability often requires surgical treatment. Several techniques are available to perform antlantoaxial stabilization, and all of these have their different advantages and disadvantages. In 2004, Wright described the C2translaminar screw fixation, which offers rigid fixation but without the technical demands of C2 pars placement and eliminates the risk of vertebral artery injury. The aim of this study is to review the C2 translaminar screw fixation technique, emphasizing operative details, risks and benefits comparing with the others atlantoaxial fixation techniques.

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Closed Reduction Transarticular Kirschner Wire Fixation Versus Open Reduction Internal Fixation in the Treatment of Bennett’s Fracture Dislocation

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(02)00307-8 ◽

2003 ◽

Vol 28 (2) ◽

pp. 142-147 ◽

Cited By ~ 41

Author(s):

M. SAILER ◽

R. LUTZ ◽

R. ZIMMERMANN ◽

M. GABL ◽

H. ULMER ◽

...

Keyword(s):

Internal Fixation ◽

Closed Reduction ◽

Open Reduction ◽

Kirschner Wire ◽

Open Reduction Internal Fixation ◽

Fracture Dislocation ◽

Fracture Fragment ◽

Bennett’S Fracture ◽

Kirschner Wire Fixation ◽

Fracture Dislocations

Thirty two patients with fracture dislocations of the base of the thumb metacarpal with a single large fracture fragment (Bennett’s fracture) were either treated by open reduction and internal fixation or closed reduction and percutaneous transarticular Kirschner wiring. All were assessed at a mean follow up of 7 (range 3–18) years. Patients with an articular step off more than 1 mm were excluded. The type of treatment did not influence the clinical outcome or the prevalence of radiological post-traumatic arthritis. The percutaneous group had a significantly higher incidence of adduction deformity of the first metacarpal. This was attributed to Kirschner wire placement near the fracture line or in the compression zone of the fracture, resulting in loss of reduction. This however did not result in an inferior outcome.

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