Novel In Situ Open Reduction and Fixation of a Displaced Type II Odontoid Fracture

Abstract

Surgical intervention for type II odontoid fractures is a common treatment strategy when conservative management is not appropriate, such as in significantly displaced fractures. However, displaced fractures may not be easily reduced with instrumentation alone. We present a novel technique, using a "bucket-handle" construct to manually reduce a dorsally displaced type II odontoid fracture, in a patient with failure of previously placed dorsal instrumentation. A 63-year-old woman underwent posterior sublaminar wiring and fixation of a type II odontoid fracture at an outside institution. Several weeks later, she presented with graft dislodgement and increased dorsal displacement and angulation of her fractured dens. After removal of her prior instrumentation and placement of segmental instrumentation, a novel construct was created using components from the instrumentation system and was attached to her cervical 2 (C2) screws. Dorsal traction on the C2 pars interarticularis screws allowed for manual reduction of her fracture via a 3-point bending moment. This reduction was secured with an occiput to C6 fixation and fusion. She is clinically and radiographically stable at 3-months follow-up. This novel "bucket-handle" construct, used in conjunction with occipitocervical fusion, allowed safe and durable manual reduction of a dorsally displaced and angulated type II odontoid fracture.