Treatment of Dens Fractures with Anterior Screw Fixation.

Abstract

Direct anterior screw fixation of the dens preserves C1-C2 rotation, and the reported fusion rates range from 88% to 100%. Exact positioning of the patient and use of image intensifiers are mandatory to obtain perfect anteroposterior and lateral views of the axis. The surgical approach is standardized, and the pretracheal layer can be exposed without violating any essential anatomic structures. The perfect entry point is directly anterior-inferior at the base of C2; therefore, the anterior rim of the C2-C3 intervertebral disc must be penetrated. We use a single cannulated screw in most cases: insert the screw in the center of the dens with its tip perforating the cranial, cortical bone of the dens just posterior to the apex. Precise and anatomic closure of the platysma determines the quality of the scar that will be visible after the operation. The patient wears a rigid collar for six weeks, removing it for body care; radiographic evaluations should be performed regularly. In a study of sixty-nine patients with a fracture of the dens, three of the thirteen patients who underwent direct anterior screw fixation had persistent instability and nonunion of the dens four months after surgery. Indications Contraindications Pitfalls & Challenges.