Versatility of Anterior approache for management of Odontoid fractures

Abstract

Odontoid fractures comprise about 20 % of all cervical fractures. Odontoid fractures have been classified according to Anderson and D’Alonzo classification system. Odontoid fractures can be managed by both anterior and posterior approaches and there are various schools of thought favouring both approaches. This paper attempts to highlight the versatility of the anterior approach to treat varying types of odontoid fractures. Indications for surgical management include age of the patient more than 55 years , displacement of fracture fragment more than 4mm, non union and disruption of transverse atlantal ligament. The odontoid has 55% less trabecular bone than the body of axis. This trabecular bone is required for callus formation and bone healing , hence non-union of type 2 fractures is more common as compared to type 3 fractures. In the present report , we have deployed 3 different techniques using the anterior approach for fixation of odontoid fracture. Plate and screw fixation is far more effective as the odontoid is a non-weight bearing structure, and it compresses the fragments for better union. In all the 3 cases , we found good evidence of radiographic healing of the fracture in the post-op period with no significant immediate or delayed complications. Neck mobility was limited to some extent with placement of transarticular screws ,but was preserved completely in the other two patients. Based on our experience with these cases , we strongly advocate that successful reduction of the fracture with adequate fusion can be achieved by using anterior approaches without restricting neck mobility (plate and screw fixation or odontoid screw fixation) and the same approach can be used to fix the C1 and C2 facet joints in case of irreducible/incompetent transverse ligament injuries.