Treatment Of Cervical Fractures Research Articles

Does Dynamic Anterior Plate Fixation Provide Adequate Stability for Traumatic Subaxial Cervical Spine Fractures at Mid-Term Follow-Up?

Background: It remains questionable if the treatment of cervical fractures with dynamic plates in trauma surgery provides adequate stability for unstable fractures with disco-ligamentous injuries. The primary goal of this study was to assess the radiological and mid-term patient-reported outcome of traumatic subaxial cervical fractures treated with different plate systems. Patients and Methods: Patients, treated with anterior cervical discectomy and fusion (ACDF) between 2001 and 2015, using either a dynamic plate (DP: Mambo™, Ulrich, Germany) or a rigid locking plate (RP: CSLP™, Depuy Synthes, USA), were identified. For radiological evaluation, the sagittal alignment, the sagittal anterior translation and the bony consolidation were evaluated. After at least two years, the patient-reported outcome measures (PROM) were evaluated using the German Short-Form 36 (SF-36), Neck Disability Index (NDI) and the EuroQol in 5 Dimensions (EQ-5D) scores. Results: 33 patients met the inclusion criteria (DP: 13; RP:20). Twenty-six patients suffered from AO Type B or C fractures. Both the sagittal alignment and the sagittal translation could be sufficiently improved in both groups (p ≥ 0.05). No significant loss of reduction could be observed at the follow-up in both groups (p ≥ 0.05). Bony consolidation could be observed in 30 patients (DP: 12/13 (92%); RP: 18/20 (90%); (p ≥ 0.05)). In 20 patients, PROMs could be evaluated (follow-up: 71.2 ± 25.5 months). The whole cohort showed satisfactory PROM results (EQ-5D: 72.0 ± 4.9; SF-36 PCS: 41.9 ± 16.2, MCS: 45.4 ± 14.9; NDI: 11.0 ± 9.1). without significant differences between the DP and RP group (p ≥ 0.05) Conclusion: The dynamic plate concept provides enough stability without a difference in fusion rates in comparison to rigid locking plates in a population that mostly suffered fragile fractures.

Selection and application of surgical techniques for upper cervical spine fractures

Appropriate surgical method selection is the basis of treatment of unstable upper cervical spine fracture. Improving the accuracy of screw placement is the key to reduce complications and enhance the efficacy. With the release of several clinical diagnosis and treatment guidelines for upper cervical fractures and the usage of various auxiliary screw placement techniques in the treatment of upper cervical fractures, the safety and efficacy of surgical treatment of unstable upper cervical fractures have made some progress, but there are still deficiencies including neurovascular injury, nonunion and failure of internal fixation caused by poor internal fixation. The author discusses how to choose the surgical method and the application of 3D printing, microscope assistance, computer navigation and robot-assisted technology in the operation of upper cervical fracture, so as to provide reference for the treatment of upper cervical fracture and provide theoretical basis for the innovation and improvement of operation technology. Key words: Spinal fractures; Cervical vertebrae; Surgical treatment

Research advance in Classification and treatment of subaxial cervical spine fractures

Research advance in Classification and treatment of subaxial cervical spine fractures

Anterior cervical distraction and screw elevating-pulling reduction for traumatic cervical spine fractures and dislocations: A retrospective analysis of 86 cases.

Treatment of cervical fracture and dislocation by improving the anterior cervical technique.Anterior cervical approach has been extensively used in treating cervical spine fractures and dislocations. However, when this approach is used in the treatment of locked facet joints, an unsatisfactory intraoperative reduction and prying reduction increases the risk of secondary spinal cord injury. Thus, herein, the cervical anterior approach was improved. With distractor and screw elevation therapy during surgery, the restoration rate is increased, and secondary injury to the spinal cord is avoided.To discuss the feasibility of the surgical method of treating traumatic cervical spine fractures and dislocations and the clinical application.This retrospective study included the duration of patients’ hospitalization from January 2005 to June 2015. The potential risks of surgery (including death and other surgical complications) were explained clearly, and written consents were obtained from all patients before surgery.The study was conducted on 86 patients (54 males and 32 females, average age of 40.1 ± 5.6 years) with traumatic cervical spine fractures and dislocations, who underwent one-stage anterior approach treatment. The effective methods were evaluated by postoperative follow-up.The healing of the surgical incision was monitored in 86 patients. The follow-up duration was 18 to 36 (average 26.4 ± 7.1) months. The patients achieved bones grafted fusion and restored spine stability in 3 to 9 (average 6) months after the surgery. Statistically, significant improvement was observed by Frankel score, visual analog scale score, Japanese Orthopedic Association score, and correction rate of the cervical spine dislocation pre- and postoperative (P < .01).The modified anterior cervical approach is simple with a low risk but a good effect in reduction. In addition, it can reduce the risk of iatrogenic secondary spinal cord injury and maintain optimal cervical spine stability as observed during follow-ups. Therefore, it is suitable for clinical promotion and application.

Comparison of Dexmedetomidine and Midazolam for sedation in elderly patients with upper cervical spine fracture in awake tracheal intubation

Objective To compare the effects of Dexmedetomidine and Midazolam for sedation in elderly patient with upper cervical spine fracture in awake tracheal intubation. Methods A total of 68 patients with upper cervical spine fracture undergoing awake tracheal intubation who treated in our hospital from Jan. 2010 to Jan. 2015 were considered as the objects, who was randomly divided into group A and group B. 34 cases in group A were treated with Dexmedetomidine for sedation, and the other 34 cases in group B were treated with Midazolam for sedation. The Heart rate (HR), mean arterial pressure (MAP) and BIS value on the before anesthesia (T1), immediately before intubation (T2), immediately after intubation (T3), PaCO2 in before and after intubation, and the adverse reactions were compared between the two groups. Results There was no difference in HR, MAP and BIS at time of T1 between the two groups (P>0.05). The HR, MAP and BIS were lower in group A than in group B at time of T2 and T3 (P 0.05). The rate of adverse effects had no difference between the two groups (χ2=1.308, P=0.253). Conclusions Compared with Midazolam, Dexmedetomidine can stable HR, MAP and BIS effectively and has a good safety in the treatment of elderly upper cervical spine fracture in awake tracheal intubation, which is worthy of clinical application. Key words: Dexmedetomidine; Midazolam; Cervical vertebrae; Fractures; Intubation, intratracheal

The posterior approach combined with pedicle screw fixation for the treatment of lower cervical fractures and dislocation

Objective To evaluate the feasibility of using the posterior approach with cervical pedicle screw fixation technique for the treatment of lower cervical spine fractures and dislocations.Methods Thirty patients suffered lower cervical fractures and dislocations were retrospectively analyzed,and they were underwent cervical pedicle screw system fixation surgery from January 2010 to December 2012.There were 22 males and 8 females,with an average age of 41 years (range,24-61 years).Eight injuries were located at C4,5,12 at C5,6,and 10 at C6.7.According to the American Spinal Cord Injury Association (ASIA)impairment scale,8 cases were grade A,12 were grade B,5 were grade C,3 were grade D,and 2 were grade E.Results Reduction and fixation of the injured segments were performed via a posterior approach in all 30 patients.One hundred and forty pedicle screws were inserted successfully in all patients on the postoperative radiographic and CT scans.All the patients were followed up for 3-23 months,with the average of 11 months.According to the ASIA impairment scale,eight cases with grade A were still grade A,but the feeling and movement improved obviously.Ten grade B improved to grade C and the rest cases were complete recovery after operations.During the course of the follow up,solid bone union was achieved in all patients,and there were no hardware failures.All the patients' postoperative MRI showed disappearance of the spinal cord compression after reduction in all cases.Conclusion For the patients of lower cervical fractures and dislocation,the first choice of operation should be the posterior approach reduction and fixation with cervical pedicle screw.The correct lengthwise traction method could unblock the locked facet effectively,and prevent the retrusion of disc and the further injury of spinal cord.For the patients of disc disruption,the posterior approach could be used only.The cervical pedicle screw system could provide three-dimensional reduction of the injured cervical segments and the adequate mechanical strength.The posterior approach combined with pedicle screw fixation is feasible and effective for the treatment of lower cervical fractures and dislocation. Key words: Cervical vertebrae; Fractures bone; Spinal cord injuries; Fracture fixation, internal

Operation choices for cervical spinal fracture in patients with ankylosing spondylitis

Objective To investigate outcomes of different operations in treatment of cervical spinal fracture in patients with ankylosing spondylitis and summarize experiences and bases in selection of operation.Methods A retrospective study was done on 19 patients with cervical spinal fracture following ankylosing spondylitis treated between 2005 and 2011 and received complete follow-up.Among them,nine patients were treated with combined anterior and posterior surgical approach (combined treatment group),seven with single posterior surgical approach (posterior approach group) and three with single anterior surgical approach (anterior approach group).Clinical data,follow-up data and image outcome of the patients were collected and compared.Results All patients received average 14 months of follow-up (range,12-20 months).In combined treatment group,the fracture was healed at postoperative 4-6 months.One patient had palsy of recurrent laryngal nerve but was recovered at postoperative three months.Seven patients with incomplete spinal cord injury had at least one level improvement in neurological function according to American Spinal Injury Association (ASIA) classification.No implant loosening or shifting were found in internal fixation.In posterior approach group,fracture was healed at postoperative 4-6 months,with no surgical complications,loosening or shifting of implants.Five patients with incomplete spinal cord injury had at least one level improvement in neurological function according to ASIA classification.In anterior approach group,an additional operation for implant loosening was performed in one patient at postoperative four weeks.The other two patients obtained fracture healing at postoperative four and five months respectively,without implant loosening.Condusions Combined anterior and posterior approaches can not only be the first choice for treatment of cervical spinal fracture following ankylosing spondylitis,but also be used for patients with bone defect at fracture site or separation at fracture end,with no necessity of postoperative external fixation.Single posterior reduction and fixation can be considered in patients with transvertebral fracture in the absence of bone defect,separation at fracture end,displacement or slight displacement,with necessary postoperative external fixation.However,single anterior fixation takes risk of implant failure and needs postoperative external fixation. Key words: Spinal fractures; Cervical vertebrae; Spondylitis, ankylosing; Internal fixators

Surgical treatment strategy for cervical spine fracture

Objective To review anterior approach, posterior approach and one-stage combined anterior-posterior approach in surgical treatment of cervical spine fracture in terms of clinical outcomes. Methods From January 2004 to January 2008, 151 patients with cervical spine fractures who had been treated in our department were reviewed. The anterior approach was used for 87 cases in disckectomy, sub-total resection of cervical vertebra and decompression, fusion, and titanium plating; the posterior approach was used for 49 cases in laminectomy of cervical vertebra for decompression, reduction, lateral mass fixation with plate and pedicle screws; the combined anterior-posterior approach was used for 15 cases. By ASIA criteria, the spinal injury was rated as degree A in 51 cases, degree B in 40, degree C in 28, degree D in 24 and degree E in 8. Results All patients were followed up for 6 months to 4 years(average, 12.5 months) . Healing was delayed in 2 cases. Reduction and restoration of the stability of cervical spine were satisfactory, and bone fusion was achieved. All patients had recovery of nerve function, though to different extents. At the last follow-up, the spinal injury was rated, by ASIA scores, as degree A in 30 cases, degree B in 24, degree C in 31, degree D in 40 and degree E in 26. The anterior and posterior surgical approaches had better ASIA scores than combined anterior-posterior approach. Conclusions It is important to choose an appropriate approach according to the type of cervical fracture. The anterior, posterior or combined ante-rior-posterior approach should be chosen mainly according to 2 aspects: the compression site of cervical spinal cord and the residual post-traumatic stability of cervical spine. Key words: Cervical vertebrae; Fracture fixation, internal; Surgical approach

One stage internal fixation with posterior transarticular screws and anterior plating for treatment of lower cervical spine fractures and dislocations

Objective To evaluate the effects of one stage internal fixation with posterior transartitular screws and anterior plating for the treatment of lower cervical spine fractures and dislocations.Methods From October 2005 to May 2007, 12 patients with fractures and dislocations of lower cervical spine were treated by one stage anterior-posterior internal fixation. Posterior transarticular screw fixation combined with anterior decompression and bone graft and anterior plating were applied for only dislocations.Anterior decompression and bone graft and anterior plating combined with posterior transarticular screw fixation were applied for the fractures and dislocations. The zygapophysial joints were fused. Results All patients were followed up for 6 to 21 (average, 14. 8) months. No loosening of the transarticular screw or nerve-vessel complication was found. Intervertebral and zygapophysial joints all got bony healing. Conclusion One stage internal fixation with posterior transarticular screws and anterior plating is an ideal method of treating lower cervical fractures and dislocations, having the advantages of simple and safe procedures, reliable fixation and a high rate of bone fusion. Key words: Cervical vertebrate; Fractures; Dislocations; Fracture fixation, internal; Screw

Treatment of multi-level cervical fractures combined with multi-level limb fractures

颈椎多发性骨折的诊断、分型和手术治疗均有其自身特点,尤其是颈椎多发性骨折并四肢多发性骨折易漏诊或延迟诊断,以至于影响疗效,甚至导致死亡,为临床工作者带来诸多难题与风险,也提出新的挑战。

Hip Fracture Treatment in Oulu — One-Year Survey with Four-Month Follow-Up

The standardized forms of the Standardized Audit of Hip Fractures in Europe (SAHFE) are aimed for the evaluation of hip fracture treatment in different hospitals and countries. The purpose was to evaluate and characterize a cohort of hip fracture patients with these forms and to evaluate their value in quality control. The non-pathological hip fractures in patients over 49 years of age treated in the Oulu University Hospital were prospectively recorded during a one-year period using SAHFE forms. There were 238 (52 male and 186 female) patients with a mean age of 78 (50-102) years. Fifty-nine percent of the patients were admitted from their own homes. Fifty-seven percent were able to walk alone outdoors and 48% could walk without walking aids before the fracture. A hundred and fifty patients had cervical fractures and 88 trochanteric fractures. The most frequent treatment of cervical fractures was Austin-Moore hemiarthroplasty (68%) and that of trochanteric fractures Gamma nail fixation (86%). At four months after the fracture, 50% lived in their own homes, 33% could walk alone outdoors and 13% could walk without any aids. Thirty-two percent had no pain in the hip. The overall mortality at four months was 17.6% and that of the operated patients 16.2%. The reoperation rate was 8.5%. SAHFE forms were very useful in the evaluation of the quality of the hip fracture treatment.

Surgical treatment of severe lower cervical fracture by one stage anterior and posterior approach

目的 探讨前后路一期手术治疗急性严重颈椎损伤的价值.方法分析总结采取前后路一期手术治疗 8例急性严重颈椎损伤病人的临床资料及治疗效果.结果所有病例均在受伤后 96 h内实施手术治疗,其中 2例为爆裂骨折伴椎管狭窄, 6例为骨折脱位伴有相应节段的椎间盘突出.术前脊髓功能 7例为 A级, 1例为 B级.平均随访 14个月.脊髓功能有 2例达到 D级, 3例 C级, 1例 B级, 2例无变化仍为 A级.所有植骨椎间隙均已融合,椎间高度及生理曲度保持良好.结论对于急性颈椎损伤,在影像学显示颈椎管前后方均有明显压迫且脊髓功能严重受损时,实施前后路一期手术是达到及时充分减压、即刻稳定、为脊髓功能恢复创造有利条件及减少并发症的有效手段.

The effect of fracture displacement on late complications in femoral neck fractures.

The importance of technical perfection in the operative treatment of cervical fractures of the upper end of the femur has been debated. Although it is clear that primary dislocation of the fracture following surgery may result from a poor technique, the opinions differ when it comes to whether a poor reduction in the long run may cause necrosis of the head or pseudarthrosis of the neck of the femur. Smith ( 19591, Garden (1961). Frangakis (1966) and others are in support of the concept of malposition after reduction and fixation as an important cause of complications later on; especially rotational and valgus position have been considered to be unfavourable. Claffey (1960) stressed that the site of the fracture was important; involvement of the lateral superior edge of the head of the femur would interrupt the circulation in the lateral epiphyseal vessels and thereby cause necrosis of the neck of the femur. However, Edholni, Lindblom & Maurseth (1966) failed to demonstrate any influence of malposition on the incidence of necrosis of the head of the femur. The object of the present study was to compare, retrospectively. primary displacement, malposition after operation and internal fixation, the type of fracture and the age at fracture between cases with and without complications.