Treatment of odontoid fractures with single anterior screw fixation

We evaluate the efficacy and safety of single anterior screw fixation in the treatment of types II and III (Anderson and D'Alonzo classification) odontoid process fractures, and analyse our surgical results. From May 1996 to October 2003, 16 patients underwent single anterior screw fixation for type II (n=12) and III (n=4) odontoid process fractures and had at least 1 year follow-up. We analyzed sex, age, associated injuries, and complications. The radiographic findings, including union rate, union time, changes of fracture shape and metal migration, were evaluated and modified Robinson criteria were used for clinical assessment. Of 16 patients, 15 (94%) achieved bony union at an average of 13.8 weeks. One patient required a secondary posterior procedure after anterior screw fixation. A full range of cervical motion was maintained in 12 patients, a limitation of <25% in three, and of >25% in one. There were no major complications related to the operative technique, including neurologic deterioration or wound infection. We conclude that single anterior screw fixation is clinically and radiologically effective and safe for type II and III odontoid process fractures.