Percutaneous Screw Fixation and Cementoplasty to Stabilize Unstable Osteolytic Fracture of Odontoid Process

Introduction: We relay a case of unstable lytic secondary fracture of odontoid process (C2) treated by screw fixation and cementoplasty, using a percutaneous approach. Case Presentation: A 62-year-old female patient followed for a breast neoplasia with bone concurrent metastases, suffered from diffuse cervical pain. A CT-scan showed a lytic fracture of C2. The procedure was performed using CT-scan guidance under general anesthesia. After a biphasic enhanced CT scan of the neck and cervical spine, a needle was slowly inserted to hydrodissect the jugulocarotid and prevertebral spaces up to the anterior cortex of C2 using an iodinated contrast agent solution diluted 5% with saline water. Under fluoroscopy guidance and intermittent CT monitoring, a bone pin was navigated though the anterior cortex of C2, and then advanced inside the vertebral body of C2. After checking for optimal positioning of the bone pin, a 34mm-long titanium screw was inserted into C2 until reaching the posterior cortex. The approach to the transverse fracture line of the body of the odontoid was tangential with no displacement of the bony parts. Cement injection was then performed. One month after the procedure, a CT scan showed no material displacement, and the patient had no visible skin scarring. The patient regained full mobility of the cervical spine, and the pain decreased from 7/10 before the procedure to 0/10 after the procedure according to the patient.Conclusion: Percutaneous screw fixation and cementoplasty to stabilize unstable osteolytic fracture of odontoid process is safe and feasible

Application of Percutaneous Screw Fixation and Closed Reduction for Tibial Plateau Fractures in Karachi, Pakistan

Objective: Objective of this study is to assess the application of percutaneous screw fixation and closed reduction for tibial plateau fractures in Karachi, Pakistan. Methods: The study design of this study is case series with sample size of 58 patients calculated by WHO calculator with functional outcome of 80-100%. The duration of the study was about 6 months.Non-probability sequential technique was adopted for data collection. Results: The average patient age was 35.35±6.84 years however male patient were high in numbers (83.8%). Types of fractures (type I, II and IV) and functional outcomes (un-satisfactory and satisfactory) showed 17(29.3%), 33(56.8%) and 12(20.6%) and 4(6.45%) and 58(93.5%). The mean Rasmussen Score was 24.6(4.9%) however significant relationship between age and functional group were observed (p<0.05). The Rasmussen Functional Scoring System and Schatzker classification were also evaluated w.r.t ache, capability of walking normally, extension lag, stability as well as range of motion. Scores ranging from 28 up till 36 stipulate excellent, from 20 to 27 good, considering score of 10 to 20 fair and 6 to 10 poor. Conclusion: The application of Percutaneous screw fixation and closed reduction for tibial plateau fractures in Karachi, Pakistanis less invasive, decrease hospital stays and charges, escalation of early mobilization along with satisfactory outcomes.