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《Chinese Journal of Spine and Spinal Cord》 2009-09
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Typing and treatment options of new odontoid fractures

YAN Ming,WANG Chao,WANG Shenlin Department of Orthopaedics,Peking University Third Hospital,Beijing,100191,China  
Objective:To summarize the treatment results of new odontoid fractures and evaluate three treatment options for new odontoid fractures according to different fracture types.Method:All 54 cases with new odontoid fractures were admitted to our hospital from Jan 2000 to Dec 2007.According to Grauer modified Anderson-D′Alonzo′s typing:7 cases with type ⅡA,23 cases with type ⅡB,8 cases with type ⅡC,16 cases with type Ⅲ.4 cases with cervical cord injuries(3 ⅡB,1 ⅡC) .The type ⅡA cases,2 type ⅡB cases incorporated with adjacent vertebrae fracture,6 type ⅡC cases and type Ⅲ cases were managed with Halo-vest.16 type ⅡB cases were treated with odontiod screw fixation.5 type ⅡB cases with severe fracture displacement and 2 type ⅡC cases were managed with posterior atlantoaxial screw-plate fusion.All cases were followed up over 24 weeks,the lateral and open mouth radiograph and CT scan of cervical vertebra were performed for viewing the union of the fractures.Result:Of 31 cases with Halo-vast treatment,30 cases showed union of fracture at 12 weeks,but 4 cases with primitive anterior displacement of fractures had malunion because of re-displacement after installation of the fixtor.1 cases with type ⅡC underwent posterior atlantoaxial screwplate fusion after 2 weeks because the fracture displaced anteriorly.Among 16 type ⅡB cases treated with anterior odontiod screw fixation,there were 3 cases developed nonunion at 24 weeks.7 cases with posterior atlantoaxial screw-plate fusion obtained bony fusion at 12 weeks.4 cases with spinal cord injuries had recovery of neurological function to some extent.Conclusion:Halo-vest is suitable to type ⅡA,non-displaced ⅡC and Ⅲ odontoid fractures,but the strength is not enough for fixation of the fractures with primitive anterior displacement.Reducible type ⅡB fracture can be treated successfully by anterior odontoid screw fixation.However,posterior atlantoaxial screw-plate fusion is better choice for type ⅡB comminuted fractures with severe displacement.
【CateGory Index】: R687.3
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