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Outcomes of surgery for unstable odontoid fractures combined with instability of adjacent segments
BACKGROUND: At present, traumatic atlantoaxial dislocation or C2-3 instability complicating odontoid fractures remains rarely reported. The aim of this study was to further investigate the surgical treatment strategies and curative effects for odontoid fractures combined with instability of adjacent...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237887/ https://www.ncbi.nlm.nih.gov/pubmed/25164238 http://dx.doi.org/10.1186/s13018-014-0064-9 |
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author | Wang, Lei Liu, Chao Zhao, Qing-hua Tian, Ji-Wei |
author_facet | Wang, Lei Liu, Chao Zhao, Qing-hua Tian, Ji-Wei |
author_sort | Wang, Lei |
collection | PubMed |
description | BACKGROUND: At present, traumatic atlantoaxial dislocation or C2-3 instability complicating odontoid fractures remains rarely reported. The aim of this study was to further investigate the surgical treatment strategies and curative effects for odontoid fractures combined with instability of adjacent segments. METHODS: This is a retrospective study of 12 patients (5 females and 7 males; age, 21–65 years) who underwent internal fixation for odontoid fractures (type II and shallow type III) and atlantoaxial instability in 6 cases, C2-3 instability in 4 cases, simultaneous C1-2 and C2-3 instability in 2 cases between January 2005 and June 2012. Accordingly, individualized surgeries were performed. Fracture healing and bone fusion were determined on X-ray scan. Upper limbs, lower limbs and sphincter functions were assessed using the Japanese Orthopaedic Association (JOA) score. Frankel grading system was used for the evaluation of neurological situation. RESULTS: Mean follow-up time of all 12 cases was 16.4 months (range, 12 to 48 months). Odontoid fracture healing was obtained in all patients within 9 months, and graft fusion was achieved within 6 months. JOA score was significantly improved from 6.3 ± 3.1 preoperatively to 11.1 ± 4.6 at 12 months after operation (P = 0.007), with 50.5 ± 25.7% recovery rate and 66.7% excellent and good rate. Except one patient still had Frankel grade B neurological injury at 12 months after surgery, the other patients improved their neurological situation (at 1 grade in Frankel scale). One patient developed wound fat liquefaction which resolved by changing the dressing. Cerebrospinal fluid leakage occurred in three patients, which resolved after the continuous drainage for 2 days. CONCLUSIONS: According to the characteristics of odontoid fractures, the individualized operative procedure should be performed, resulting in high fracture healing rate, function recovery rate, and less, transient complications. |
format | Online Article Text |
id | pubmed-4237887 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-42378872014-11-21 Outcomes of surgery for unstable odontoid fractures combined with instability of adjacent segments Wang, Lei Liu, Chao Zhao, Qing-hua Tian, Ji-Wei J Orthop Surg Res Research Article BACKGROUND: At present, traumatic atlantoaxial dislocation or C2-3 instability complicating odontoid fractures remains rarely reported. The aim of this study was to further investigate the surgical treatment strategies and curative effects for odontoid fractures combined with instability of adjacent segments. METHODS: This is a retrospective study of 12 patients (5 females and 7 males; age, 21–65 years) who underwent internal fixation for odontoid fractures (type II and shallow type III) and atlantoaxial instability in 6 cases, C2-3 instability in 4 cases, simultaneous C1-2 and C2-3 instability in 2 cases between January 2005 and June 2012. Accordingly, individualized surgeries were performed. Fracture healing and bone fusion were determined on X-ray scan. Upper limbs, lower limbs and sphincter functions were assessed using the Japanese Orthopaedic Association (JOA) score. Frankel grading system was used for the evaluation of neurological situation. RESULTS: Mean follow-up time of all 12 cases was 16.4 months (range, 12 to 48 months). Odontoid fracture healing was obtained in all patients within 9 months, and graft fusion was achieved within 6 months. JOA score was significantly improved from 6.3 ± 3.1 preoperatively to 11.1 ± 4.6 at 12 months after operation (P = 0.007), with 50.5 ± 25.7% recovery rate and 66.7% excellent and good rate. Except one patient still had Frankel grade B neurological injury at 12 months after surgery, the other patients improved their neurological situation (at 1 grade in Frankel scale). One patient developed wound fat liquefaction which resolved by changing the dressing. Cerebrospinal fluid leakage occurred in three patients, which resolved after the continuous drainage for 2 days. CONCLUSIONS: According to the characteristics of odontoid fractures, the individualized operative procedure should be performed, resulting in high fracture healing rate, function recovery rate, and less, transient complications. BioMed Central 2014-08-28 /pmc/articles/PMC4237887/ /pubmed/25164238 http://dx.doi.org/10.1186/s13018-014-0064-9 Text en Copyright © 2014 Wang et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Wang, Lei Liu, Chao Zhao, Qing-hua Tian, Ji-Wei Outcomes of surgery for unstable odontoid fractures combined with instability of adjacent segments |
title | Outcomes of surgery for unstable odontoid fractures combined with instability of adjacent segments |
title_full | Outcomes of surgery for unstable odontoid fractures combined with instability of adjacent segments |
title_fullStr | Outcomes of surgery for unstable odontoid fractures combined with instability of adjacent segments |
title_full_unstemmed | Outcomes of surgery for unstable odontoid fractures combined with instability of adjacent segments |
title_short | Outcomes of surgery for unstable odontoid fractures combined with instability of adjacent segments |
title_sort | outcomes of surgery for unstable odontoid fractures combined with instability of adjacent segments |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237887/ https://www.ncbi.nlm.nih.gov/pubmed/25164238 http://dx.doi.org/10.1186/s13018-014-0064-9 |
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