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Treatment of Dens Fractures with Anterior Screw Fixation
Markus R Konieczny1, Arnold Gstrein2, Ernst J Müller2
1Department of Orthopedic Surgery, University Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
Introduction:
Direct anterior screw fixation of the dens preserves C1-C2 rotation, and the reported fusion rates range from 88% to 100%.
Step 1 Positioning Of The Patient:
Exact positioning of the patient and use of image intensifiers are mandatory to obtain perfect anteroposterior and lateral views of the axis.
Step 2 Surgical Approach:
The surgical approach is standardized, and the pretracheal layer can be exposed without violating any essential anatomic structures.
Step 3 Entry Point Of The Screw:
The perfect entry point is directly anterior-inferior at the base of C2; therefore, the anterior rim of the C2-C3 intervertebral disc must be penetrated.
Step 4 Screw Insertion:
We use a single cannulated screw in most cases: insert the screw in the center of the dens with its tip perforating the cranial, cortical bone of the dens just posterior to the apex.
Step 5 Wound Closure:
Precise and anatomic closure of the platysma determines the quality of the scar that will be visible after the operation.
Step 6 Follow-Up:
The patient wears a rigid collar for six weeks, removing it for body care; radiographic evaluations should be performed regularly.
Results:
In a study of sixty-nine patients with a fracture of the dens, three of the thirteen patients who underwent direct anterior screw fixation had persistent instability and nonunion of the dens four months after surgery. Indications Contraindications Pitfalls & Challenges.
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