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Fractures of the dens. A multicenter study
The Journal of Bone and Joint Surgery. American Volume
|December 1, 1985
Summary
Posterior cervical fusion is the most effective treatment for troublesome Type-II dens fractures, achieving 96% success. Other treatments like halo devices show lower success rates for these serious cervical spine injuries.
Area of Science:
- Orthopedic Surgery
- Neurosurgery
- Traumatology
Background:
- Fractures of the dens (the dens axis) are challenging injuries with varied surgical opinions.
- Effective classification and management strategies for dens fractures are crucial due to their potential severity.
Purpose of the Study:
- To survey members of the Cervical Spine Research Society regarding the management of dens fractures.
- To identify optimal treatment strategies for different types of dens fractures based on multicenter data.
Main Methods:
- A multicenter survey was conducted among members of the Cervical Spine Research Society.
- Fractures were classified using the Anderson and d'Alonzo system, considering angulation and displacement.
Main Results:
- Type-II fractures (at the junction of the dens and vertebral body) were most problematic.
- Posterior cervical fusion demonstrated a 96% success rate for Type-II fractures, superior to halo devices (68% success).
- Type-III fractures extending into the vertebral body showed risks of malunion and non-union with orthosis alone.
Conclusions:
- Posterior cervical fusion is the preferred treatment for Type-II dens fractures.
- Type-III dens fractures may require halo devices or surgical intervention due to instability and potential for poor outcomes.