Treatment of Dens Fractures with Posterior Transarticular Fixation
Markus R Konieczny1, Arnold Gstrein2, Ernst J Müller2
1Department of Orthopedic Surgery, University Hospital of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
Introduction:
Treatment of unstable dens fractures with posterior transarticular C1-C2 arthrodesis provides a biomechanically stable construct, even when poor bone quality is present, and a low rate of complications even in elderly patients; however, when this method of fixation is performed, cervical spine rotation is substantially reduced as compared with that associated with alternative fixation techniques.
Step 1 Positioning:
Exact positioning of the patient and use of image intensifiers are mandatory to obtain appropriate anteroposterior and lateral views of C1 and C2.
Step 2 Surgical Approach:
Use the modified technique of Magerl and Seemann, as it allows a less extensive approach to C1 and C2, and the drill can enter through two incisions at the level of T1.
Step 3 Insertion Of Screws:
Use smooth 2.0-mm Kirschner wires to prepare the canal for the screws, and subsequently replace them with 3.0-mm self-tapping screws.
Step 4 Gallie Fusion:
Perform a modified Gallie fusion, in addition to the transarticular screw fixation, to increase stability and osseous fusion between C1 and C2.
Step 5 Wound Closure:
Perform meticulous closure of the wound to avoid wound-healing complications.
Results:
In our original study, we treated twenty-five patients with posterior transarticular fixation.IndicationsContraindicationsPitfalls & Challenges.
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