[Surgical therapy of dens fracture]

The use of Anderson/D'Alonso or Aebi/Nazarian classification of dens fractures is the basis for exact selection of therapy. The ventral screw-fixation of Anderson type-II-Fracture is today the common standard of treatment, especially in the elderly. The stabilisation of the fracture with maintenance of atlanto-axial rotation-function, the minimal rate of pseudarthrosis compared with conservative therapy, the minimal operation trauma and the immediate mobilisation with high patient comfort are decisive benefits of this method. Reposition of the fracture, visualisation in two planes and the use of adequate instruments are important conditions to get optimal operation results. In-vitro-experiments have shown that there is no difference of stability in one- or two-screw-technique. Flexion injuries with oblique fracture plane, insufficient stability after anterior screw fixation and typ-III-fractures are indications for dorsal, atlanto-axial screw fixation. The conservative treatment(HALO-vest) is recommended only in otherwise inoperable patients.