The healing of old odontoidum fractures after rigid internal fixation for atlanto-axial fusion

English Keywords:Odontoid fracture  Atlanto-axial instability  Dislocation  Old

English Abstract:

  【Abstract】 Objectives: To investgate the healing result of old odontoid fractures treated with rigid internal fixation and posterior atlanto-axial fusion. Methods: Clinical history, radiographic films, CT and MRI images of 82 consecutive cases with old odontoid fractures were studied retrospectively. 42 patients who had CT scan reconstruction images both before and after operation were taken to confirm the pathological changes in the fracture sites. The cases were operated with posterior internal fixation and fusion respectively in 5 cases at 3-8 weeks, in 30 cases at 8-36 weeks, in 7 cases beyond 36 weeks after injuries. The fixation of C1 lateral mass screw and C2 pedical screw was performed in 40 cases and C1-2 transarticular screw in 2 cases. The following-up was done until the atlanto-axial fusion was completed. Results: The atlanto-axial fusion was completed in all cases. Concurrently the healing of odontoid fractures appeared in 30 among 42 cases. There were 4 suspected healing cases and 8 non-healing cases. The healing time was 4 months for 28 cases, 6 months for 1 case and 9 months for 1 case, respectively. Conclusions: Rigid atlanto-axial fixation is effective and satisfactory for the healing of old odontoid fractures and maybe also indicated to fresh odontoid fractures.