[Comparative clinical study assessing C2 dens injuries treatment outcomes]

The aim of this restrospective study was to compare treatment outcomes of C2 dens fractures following their conservative or surgical management, using direct osteosynthesis with canalised screws and the Dens Access device. During 1999-2006, 108 patients with type II and type III dens injuries, based on the Anderson-D'Alonzo classification, were treated in the Brno Traumatology Hospital (Urazová nemocnice Brno). Patients with type I injuries were excluded from the study. The study included 32 patients, who presented for a chek-up. Out of the total, 15 patients had undergone surgery, 17 had been managed conservatively. The mean age was 56 years (17-83 y.o.a.), 19 subjects were males and 13 subjects were females. The conservative treatment included the following methods: treatment with a Philadelphia collar (4 subjects) or a halo apparatus (13 subjects). Only patients, in whom at least a year elapsed since their injury, were included in the study. The control group showed inferior results on ROM (range of motion), VAS (Visual analogue scale) and x-ray examinations. Overall, in the conservative group, 3 subjects showed restricted cervical range of motion, compared to a single subject in the operated group. The mean VAS was 3.6 (0-7) in the conservative group, compared to the mean VAS of 2.9 (0-6) in the operated group. No fragment displacements or development of a pseudojoint was recorded in the operated subjects. In the conservative group, fragment displacement was observed in 2 subjects. In the both subjects, the bone healed. The Fisher's exact test and the Mann-Whitney U-test were used for statistical analysis of the data.