Anterior Transcervical Lag Screw Fixation of Type II Odontoid Fracture

Odontoid fracture comprises approximately 20% of all cervical spine fractures. Among them type II fracture accounts for about 65-74%. Presently, direct anterior screw fixation is considered to provide successful outcome with fracture healing of 80% and also preserve C1/C2 rotation movement with benefit of early mobilization and rapid return to normal life style. Recent fracture(<6months) have high fusion rate of 90% with this approach and for remote fracture(≥18months) it reduces to 25%. Here we present a case report of 18 years old female with type II odontoid fracture and underwent anterior transcervical lag screw fixation under C-arm guidance.

Four-Corner Arthrodesis: Description of Surgical Technique Using Headless Retrograde Crossed Screws

Background: Four-corner fusion has been shown to be a reliable option of treatment of wrist arthritis, but there is no consensus about which implant and surgical procedure should be used in the arthrodesis. The present study aimed to describe a surgical technique using 2 crossed screws as implants, inserted in a retrograde manner, and to demonstrate preliminary results of the use of the technique. Methods: A retrospective study was conducted using medical records and imaging tests (radiographs and computed tomography) of all 15 patients who underwent a standardized 4-corner fusion technique, between December 2011 and July 2015, in the Department of Hand Surgery of Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, Brazil. We collected data on the following variables: fusion rate, time to fusion, and percentage of patients who had any complications or needed another surgical procedure on the same wrist. Results: All but one patient achieved fusion of arthrodesis. The average time to union was 5.54 months (SD = 3.84). Only the patient who developed nonunion of the 4-corner fusion required another surgery on the same wrist. Conclusions: The procedure described in this study demonstrated a low complication rate and high fusion rate, and can therefore be considered a reliable surgical technique for 4-corner fusion.

Avoiding pitfalls in anterior screw fixation for Type II odontoid fractures

Anterior screw fixation of Type II odontoid fractures provides immediate stabilization of the cervical spine while preserving C1–2 motion. This technique has a high fusion rate, but can be technically challenging. The authors identify key points that should be taken into account to maximize the chance for a favorable outcome. Keys to success include proper patient and fracture selection, identification of suitable screw entry point and correct screw trajectory, achieving bicortical purchase, and placing 2 screws when feasible and applicable. The authors review the operative technique and present guidance on appropriate patient selection and common pitfalls in anterior screw fixation, with strategies for avoiding complications.

Long-Term Results of Arthroscopic Ankle Arthrodesis

Background: More than 40 open procedures have been described for ankle arthrodesis, most with high complication rates. Since its description in 1983, arthroscopic ankle arthrodesis has become a viable option in selected patients. With one of the largest series in the literature, the purpose of the paper was to analyze the results of arthroscopic ankle arthrodesis at our institution. Methods: Between 1989 and 2002, 35 patients with end-stage ankle arthritis underwent arthroscopic ankle arthrodesis. The average followup was 72 months, with a range of 24 to 167 months. Patients returned for a clinical and radiolographic evaluation using the grading systems of Mazur and Morgan. All patients had preoperative and postoperative radiographic evaluation to assess fusion. Indications for arthroscopic ankle arthrodesis included failure of at least 6 months of conservative treatment, minimal or mild correctable deformity in the coronal plane, and no active infections. Results: The overall fusion rate was 97% (34 of 35 patients). The average time to fusion was 11.8 weeks, with a range of 8 to 18 weeks. There were 74% good to excellent results by the Mazur grading system and 83% by the Morgan system. There were no infections or neurovascular injuries. In the three patients who required bone stimulators for delayed unions, fusion occurred in two, and one had a nonunion. Eleven patients had screws removed because of pain at an average of 11 months after the initial surgery. Conclusion: Our study demonstrated a high fusion rate with minimal complications for arthroscopic ankle arthrodesis.

Intercarpal Arthrodesis by Dowel Bone Grafting

Successful intercarpal arthrodesis requires a stable fusion with maintenance of correct alignment and spatial relationship of the carpus. The technique described utilizes a series of tube saws to fashion the arthrodesis bed and then insert a sized iliac crest dowel bone graft with a tight interference fit. This technique has been used in 24 patients over a two-year period in both medial and lateral column intercarpal fusions. All wrists had fused by the tenth post-operative month. The technique is precise, reproducible and technically simple with a high fusion rate and minimal donor site morbidity.