![]() Institutional review board approval was not necessary, as surgical treatment is the standard of care for most unstable odontoid fractures. Informed consent for surgery was obtained from all patients and next of kin. ![]() Magnetic resonance imaging (MRI) was performed to study cord injury, and magnetic resonance angiography was performed for vertebral artery position and associated spinal cord trauma. None had realigned before surgery.Īpart from routine investigations for fitness for surgery, all patients underwent lateral radiographs for diagnosis and reducibility after traction and computerized axial tomography (CT) scanning with bone window settings and three-dimensional (3D) reconstruction to study the displacement of the fracture fragment and the facetal malalignment (atlantoaxial dislocation), other fractures, and bone stock for length of screws required. Over the years, we realized the success of the procedure to realign almost all fractures and started taking patients earlier for surgery. Skull traction (Gardner-Wells tongs) was applied in all cases, and a trial of 3 days was given to 5 patients. Twelve patients underwent surgery within 3 days of injury, and the remaining 3 patients underwent surgery within 10 days of injury. Most were males (13 males/2 females ages: 21–64 years), and 13 patients were less than 40 years old. Mechanisms of trauma included motorcycle accidents (9 patients), high-speed car accidents (2 patients), diving (2 patients), and falls from high heights (2 patients). Fractures were considered irreducible after they remained displaced and irreducible in spite of a 3-day trial of skull traction up to 12 kg. Open reduction internal fixation by a single-stage unilateral direct anterior extrapharyngeal approach may be another option for successful fracture realignment and atlantoaxial fixation resulting in solid bony fusion in unstable, irreducible odontoid fractures.īetween February 2011 and December 2020, we surgically treated 15 patients with unstable odontoid fractures with irreducible atlantoaxial dislocation. Posterior manipulation and realignment with fixation in properly selected cases has been described recently. Transoral decompression followed by posterior stabilization has been the main option. The absence of standard guidelines about traction and a small but certain chance of devastating deterioration following traction are causes of concern, and most surgeons would plan early surgical realignment and stabilization. Following diagnosis, immediate attempt to realign the bones with skull traction is a standard procedure. These may be associated with significant cord injury and associated trauma (brain, viscera, and long bones). Irreducible unstable odontoid fractures are more common in young patients with high-impact and high-velocity trauma when strong disruptive forces act upon the osseoligamentous complex at the base of the skull. Fracture displacement and irreducibility is multifactorial following odontoid trauma.
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