[Modified Kirschner wire insertion for direct ventral screw fixation of dens fractures]

Since 1985 25 patients with a fracture of the odontoid process (dens) were operated in the Neurosurgical Department of the Justus-Liebig-University in Giessen. An early stabilization through an anterior approach was favoured for type II fractures, and for displaced type III injuries, according to the classification of Anderson and d'Alonzo. Two double threaded screws were implanted to reach a compression between the fragments and a stabilization of rotation. With patients having a large thoracic volume and/or a short neck there are often problems, to insert the K-wires in the correct angle, before the screw fixation is performed. For these cases we have developed a new device for the K-wire insertion. After technical examinations in specimen the device was successfully applied in clinical use. This device with its inherent advantages is presented and discussed in this paper.