Anterior single lag screw fixation in type II Dens fracture - indian experience

Increased rate of non-union of Type II Odontoid fractures with rigid external orthosis have been reported. Recently technique of direct anterior screw fixation of the odontoid fracture is being advocated. Here we report the results of 13 cases of Type II dens fracture treated by the above method with an age group ranging from 17 to 73 years. An approach identical to the anterior cervical discectomy was used. Guide tube system devised by Synthes®, single image intensifier and Langenberg retractors was used to place a single cannulated screw through the fracture from C2 body into the dens. Among the 13 cases operated, in 11 cases we were successful. In one case while dissecting the fracture site CSF leak occurred and in another case the guide wire broke leading to abandoning to screw placement. There was no other complication due to the surgical procedure. The follow up period ranged between 2 months to 3 1/2 years. There were no neurological complications or screw fracture. In 9 of the 11 cases (82%) either bony union or fibrous unions have occurred. These results indicate that direct anterior single screw fixation has proved to be a very successful treatment.