Percutaneous Anterior Screw Fixation Research Articles

Multi-holed biplane drill guide-assisted percutaneous anterior odontoid screw fixation.

The use of percutaneous anterior screw fixation for odontoid fractures has been widely reported. Because the anatomical characteristics of the odontoid and the screw occupy three-dimensional space, it is challenging to establish the screw trajectory quickly and correctly during the operation. The purpose of this study was to introduce a multi-holed biplane drill guide that can be used to optimize the guide needle trajectory in percutaneous anterior odontoid screw fixation. Twenty-one patients with type II or rostral type III odontoid fractures were treated with percutaneous anterior single screw fixation. Of these, 12 patients had an unsatisfactory initial guide needle position. A drill guide was used to provide a variety of guide needle tracks. All 12 patients successfully underwent guided screw placement without vascular or neurological complications. Postoperative X-ray and/or CT scans showed that the internal fixation position was satisfactory. At the end of the follow-up period, all patients exhibited bony union without loosening or fractures of the internal fixation. With the imperfect initial position of the guide needle as a reference, the multi-holed biplane drill guide can provide a variety of needle trajectory options in the sagittal and coronal planes for percutaneous anterior odontoid screw fixation. The operator can quickly obtain the ideal guide needle trajectory.

Surgical treatment by percutaneous anterior screw fixation of scaphoid fractures

The aim of this study was to evaluate the results of percutaneous screw fixation of scaphoid waist fractures in our surgery unit by comparing them with recent data from the literature. This was a retrospective, descriptive study conducted between January 2010 and September 2016. Patients operated due to a recent scaphoid fracture and treated by percutaneous anterograde screw fixation with a Herbert screw were included in this study. Our cohort was a sub-set from a scaphoid fracture group; other fracture sites, other treatment techniques and fractures associated with scapholunate ligament lesions were excluded. The time to union and union rate were recorded. The Youm and McMurtry indices, scaphoid and scapholunate angles were measured on radiographs. A total of 21 patients were included. The mean age was 30 years (18–44) and the sex ratio (male/female) was 9.5. The union rate was 95% with an average follow-up of 24 months. Four patients had a mobility deficit in the sagittal plane of about 9°. No malunion was found, and no major complications were observed. Based on this study, percutaneous fixation of the scaphoid with Herbert's screw is a reliable technique that leads to union in most cases with limited postoperative immobilization.

Percutaneous anterior screw fixation in the treatment of odontoid fractures

Objective To retrospectively analyze the treatment of odontoid fractures using percutaneous and open anterior screw fixation,and compare the clinical and radiographic results of the two techniques.Methods From March 2003 to May 2010,115 patients with odontoid fracture were treated with anterior screw fixation,and all patients were followed up.The mean age of the patients was 43.5 years (range,16-71).Forty-seven patients who underwent percutaneous anterior screw fixation were set as the percutaneous fixation group,including 42 cases of type Ⅱ odontoid fracture and 5 of rostral type Ⅲ fracture.Sixtyeight patients who received open anterior screw fixation were set as the open fixation group,composing of 61cases of type Ⅱ odontoid fracture and 7 of rostral type Ⅲ fracture.We compared the operative time,intraoperative blood loss,X-ray exposure time,fracture union and complications between the two groups.Results The average follow-up duration was 37.6 months with a range of 12-70 months.The gender,age,classification of odontoid fractures,time after the injuries and concomitant spinal injuries showed a similar pattern in both groups.The operating time and intra-operative blood loss in percutaneous fixation group were (40.3±9.5)min and (5.6±4.1) ml respectively,and in open fixation group were (62.9±15.3) min and (47.1±28.6) ml respectively,both of them were significantly superior in percutaneous fixation group than in open fixation group (P＜0.05).There was no statistical difference in radiation exposure time,fracture union and incidence of complication between the two groups.Conclusion Comparing with open screw fixation,percutaneous anterior screw fixation is a safe and reliable procedure for treatment of type Ⅱ and rostral type Ⅲ odontoid fractures with potential advantages. Key words: Odontoid process; Fracture fixation, internal; Surgical procedures, minimally invasive

Comparison of Percutaneous and Open Anterior Screw Fixation in the Treatment of Type II and Rostral Type III Odontoid Fractures

Prospective controlled study of the clinical and radiographic results of a group of 42 cases having undergone anterior screw fixation for type II and rostal type III odontoid fractures. The objective of this study is to determine the safety and efficacy of percutaneous anterior screw fixation as an alternative new technique in the management of type II and rostal type III odontoid fractures. Minimally invasive spinal techniques have only recently been developed. However, clinical and radiographic outcome of minimally invasive anterior screw fixation for odontoid fractures has been evaluated in very few studies. There have been no prospective clinical reports published on the comparison of percutaneous anterior screw fixation for type II and "shallow" type III odontoid fractures or a traditional open manner. Forty-two patients, 26 men and 16 women, with an average age of 47.1 years (32-65) were prospectively evaluated. All patients underwent percutaneous anterior screw fixation(n = 19) or open screw fixation (n = 23). The following data were compared between the two groups: operative time, blood loss, radiograph exposure time, the clinical and radiographic results, and complications. Radiologic examination of the cervical spine with plain radiographs was performed at 3, 6, and 12 months after surgery. In comparison with open fixation group, percutaneous fixation group had significantly less operating time and less blood loss. The radiation time and clinical outcome were basically identical in two groups. Radiographic evaluation showed satisfactory bony union and no evidence of abnormal movement at the fracture site in both percutaneous fixation group (18 of 19 cases) and open fixation group (22 of 23 cases). Two cases of postoperative dysphagia occurred in open screw fixation group. Percutaneous anterior screw fixation is a safe and reliable procedure for treatment of type II and rostral type III odontoid fractures with potential advantages.

Therapeutic effects and complications of percutaneous anterior screw fixation for odontoid fractures

To investigate the therapeutic effects and complications of percutaneous anterior screw fixation for odontoid fractures. Twenty-eight patients with odontoid fractures, 21 males and 7 females, aged 38.6 (21-72), 12 with type II fractures and 16 with type III fractures, including 10 cases with shallow type III fractures, according to Anderson's classification system, underwent percutaneous anterior odontoid screw fixation with one screw implant. Five to seven days after the operation the patients got out of bed to conduct dirigation. Prostheses were used for 8-12 weeks post-operationally. The patients were followed up for 43.2 months (26-62 months). Radiological examination, including X-ray and CT examinations, and clinical examinations were carried out to observe the therapeutic effects. Radiological examination showed bony union in 25 cases (89.3%), and non-union developed in 2 cases, 1 case was switched to posterior fusion surgery because of redisplaced fracture. The union rate was 83.3% in the type II fracture, and was 93.8% in the type III. Majority of the patients resumed an excellent cervical motion. No severe complication such as esophagus and carotid artery injury related with puncture was found. One patient had temporary superior laryngeal nerve paralysis, The screw tail was detained at the superior margin of C3 vertebral body in 5 cases, the screw penetrate the tip of odontoid process in 1 case, and the screw thread failed to pass the fracture site entirely in 1 case. An innovative alternative method with the advantages of convenient procedure, less bleeding, gentle injury for surrounding tissue, and rapid recovery, percutaneous anterior odontoid screw fixation is similarly effective as open anterior odontoid screw fixation, for the treatment of odontoid fractures. Related complication is rare and not severe. The surgery has.