Treatment of Dens Fractures with Posterior Transarticular Fixation

• Published in: JBJS essential surgical techniques 2014-05, Vol.4 (2), p.e10-e10
• Main Authors: Konieczny, Markus R., Gstrein, Arnold, Müller, Ernst J.
• Format: Article
• Language: English
• Subjects: Scientific
• ISSN: 2160-2204; 2160-2204
• DOI: 10.2106/JBJS.ST.M.00073

Treatment of unstable dens fractures with posterior transarticular C1-C2 arthrodesis provides a biomechanically stable construct, even when poor bone quality is present, and a low rate of complications even in elderly patients; however, when this method of fixation is performed, cervical spine rotation is substantially reduced as compared with that associated with alternative fixation techniques. Exact positioning of the patient and use of image intensifiers are mandatory to obtain appropriate anteroposterior and lateral views of C1 and C2. Use the modified technique of Magerl and Seemann, as it allows a less extensive approach to C1 and C2, and the drill can enter through two incisions at the level of T1. Use smooth 2.0-mm Kirschner wires to prepare the canal for the screws, and subsequently replace them with 3.0-mm self-tapping screws. Perform a modified Gallie fusion, in addition to the transarticular screw fixation, to increase stability and osseous fusion between C1 and C2. Perform meticulous closure of the wound to avoid wound-healing complications. In our original study, we treated twenty-five patients with posterior transarticular fixation.IndicationsContraindicationsPitfalls & Challenges.