[Is it possible to detect Staphylococcus aureus colonization or bacteriuria before orthopedic surgery hospitalization?]. / Le dépistage en ambulatoire des patients porteurs de Staphylococcus aureus ou présentant une colonisation urinaire et devant bénéficier d'une chirurgie orthopédique est-il réaliste ?

AIM OF THE STUDY: Evaluate the feasibility of Staphylococcus aureus nasal colonization and bacteriuria screening in outpatients before realizing a decolonization treatment in S. aureus carriers and a bacteriuria treatment before hospitalization. METHODS: All patients undergoing hip, knee or back surgery in which prosthesis were implanted between October 2007 until the end of June 2008 were included. Microbiological studies were performed before hospitalization. Notice for S. aureus decolonization regimen was delivered to each patient and to the general practitioner only if the patient had nasal carriage. RESULTS: Only 91.2% (240/263) of patients had microbiological results. Prevalence of S. aureus colonization was 21.4% (48 positives/224). Three patients were colonized with methicillin-resistant staphylococci. Decolonization regimen was applied before surgery to 70.8% (n=34) of the colonized patients. Among the patients, 8.9% (20/225) had bacteriuria, Escherichia coli being the most frequent micro-organism (n=16). CONCLUSION: Preoperative search and management of S. aureus colonization and of bacteriuria in outpatients is possible. Monitoring record must be performed by a member of the hospital staff.

[Capitolunate arthrodesis with tension band wire in wrist arthritis: twenty cases with four year follow-up]. / L'arthrodèse capitato-lunaire par hauban dans l'arthrose du poignet: à propos de vingt cas au recul moyen de 4 ans.

PURPOSE OF THE STUDY: Treatment of degenerative osteoarthritis of the wrist is aimed at preserving wrist motion and force while reducing pain. Limitation of the degenerative processes to certain joints raises the possibility of intracarpal arthrodesis, e.g. capitolunate arthrodesis. We present results of this procedure with a tension band wire in patients with arthritic degenerative disease of the wrist. MATERIAL AND METHODS: The series included 20 patients reviewed at mean 47 months. Mean age was 53.5 years. Pain was the main complaint. Wrist force and motion were decreased in all patients. All patients presented osteoarthritic disease of the wrist with preservation of the radiolunate space. The operation consisted in total scaphoidectomy and capitolunate arthrodesis maintained with a tension band wire. Force, pain (Mayo clinic score) and force (Jamar dynamometer) were recorded. The Cooney function score was determined and six patients completed the French Dash questionnaire. Radiolunate and capitolunate angles were noted as well as the index of carpal height measured preoperatively and at last follow-up. RESULTS: Nineteen of the 20 arthrodeses fused. A revision graft was successful for the one nonunion. Pain was the only clinical factor which improved significantly (p<0.0001) in all patients. Lunatum extension (DISI) and capitatum flexion did not have any effect on functional outcome. Sixteen patients resumed their activities at the same level. DISCUSSION: The results of this series are similar to those in the literature concerning four-way arthrodesis. Capitatolunate arthrodesis with partial arthrodesis of the carpus has been proposed for arthritic degeneration of the wrist with a preserved radiolunate space. We prefer this procedure to four-way arthrodesis because useful motion and wrist force are preserved with constant and effective significant pain relief.

Preoperative embolization of a cervicodorsal paraganglioma by direct percutaneous injection of onyx and endovascular delivery of particles.

We report the feasibility and efficacy of percutaneous injection of Onyx (Micro Therapeutics, Irvine, Calif.), a nonadhesive liquid embolic agent, into an unusually located paraganglioma, followed by endovascular embolization with particles before surgery.

[Anatomic variations of the ilio-caval junction encountered in disk prosthesis implantation]. / Incidence de la situation anatomique de la bifurcation ilio-cave lors de la mise en place d'une prothèse discale.

PURPOSE OF THE STUDY: The retroperitoneal mini-invasive anterior approach to the lumbar spine is widely used for disc excision and insertion of a prosthetic disc. A large operating window is needed. Venous wounds constitute one of the most serious complications. We analyzed the angle and position of the iliocaval on the preoperative angio-MRI in search for correlations with the intraoperative findings. Our aim was to determine whether the preoperative angio-MRI gives indications concerning the operative difficulty and the best strategy for prosthesis fitting. MATERIAL AND METHOD: This prospective study included 35 consecutive patients who underwent surgery for implantation of a Maverick disc prosthesis. Average patient age was 46.7 years. The indication for surgery was isolated degenerative discopathy with invalidating chronic low back pain without alteration of the muscle masse or facet joints. A preoperative angio-MRI was performed with T1 spin-echo sequences for the coronal slices and T2 axial slices passing through the upper extremity of the L5-S1 disc. We searched for correlations between the MRI and operative findings. Elements studied were those used in the Capellades classification: height of the iliocaval junction (high, very high, low, very low), position of the common iliac vein (lateral, intermediate, medial), angle formed by the two common iliac veins. RESULTS: The lateral position was the most frequent (31.5%). The average junction angle was 65 degrees). The only position where it was not possible to "pass" under the iliocaval junction was for a very low medial localization with a narrow angle (45 degrees). DISCUSSION: Our series included a homogenous group comparable with other series in the literature. The junction angle for very low medial localizations is of considerable importance because it is impossible to fit the implant in the L5-S1 under the iliocaval junction if the angle is over 60 degrees. CONCLUSION: The position of the iliocaval junction, and particularly its angle, are of considerable importance for insertion of an L5-S1 disc prosthesis. The preoperative angio-MRI provides information on the potential difficulty of the insertion. In addition, with this preoperative information, the patient can be warned that it may not be possible to insert the implant so that a therapeutic alternative may be proposed.

[High tibial open-wedge osteotomy using a tricalcium phosphate substitute: 70 cases with 18 months mean follow-up]. / Valgisation tibiale par ouverture médiale utilisant un coin de céramique de phosphate tricalcique: á propos de 70 cas revus avec un recul moyen de 18 mois.

PURPOSE OF THE STUDY: We report our experience with a B tricalcium phosphate ceramic to fill open-wedge tibial osteotomy gaps. MATERIAL AND METHODS: Seventy high tibial open-wedge osteotomies were performed in 70 patients (47 men and 23 women). Ostotomy was performed for osteoarthritis in 56 knees, Ahlback classification stage I (n = 18), stage II (n = 32), stage III (n = 6) and for congenital varus in 14. Mean patient age was 45.2 years (16-69). We used a wedge-shaped piece of ceramic with an appropriate angle, which was associated with granulated material to complete the gap filling for the last 20 cases. One or two staples were used for fixation. Clinical and radiological outcome was assessed at 6 weeks, 3 months, 6 months, and at last follow-up. Mean follow-up was 18 months. RESULTS: There were no biological or clinical complications related to biomaterial intolerance. Tolerance to the osteosynthesis material was mediocre since we observed one infection and 12 cases of pain related to the staples which required material removal in 8 patients. Bone healing was achieved in 98.5%. Final correction was between 3 degrees and 6 degrees valgus in 80.5%. There was a loss of correction angle between the postoperative film and the bone healing film. Factors related to sustained correction were: non-fractured wedge, intact lateral tibial cortical, osteosynthesis with two staples. Osteointegration was good and rapid in 96%. We found two complete lucent lines at last follow-up but with variable resorption depending on the shape of the bone substitute. CONCLUSION: Use of a ceramic wedge to fill high tibial medial open-wedge osteotomy gap is a reliable reproducible technique providing correction without formation of a malalignment callus. Bone healing is achieved in 98.5% of the cases at about three months. Osteointegration is good in 96%. Resorption is complete and rapid when the substitute is implanted in granular form in a cancellous zone and is partial and slow when implanted as a massive wedge.

[Video-assisted mini-thoracotomy for surgical treatment of thoracolumbar junction fractures]. / Traitement des fractures de la charnière thoraco-lombaire par thoracotomie mini-invasive vidéo assistée: a propos de 20 cas.

PURPOSE OF THE STUDY: There are several solutions for the treatment of fractures of the thoracolumbar junction (classical anterior, posterior, combined approaches). The advent of video-assisted minimally invasive techniques has helped minimize complications. The aim of this work was to analyze the clinical and radiological outcome in a prospective series of 20 patients who underwent video-assisted mini-thoracotomy for the treatment of thoracolumbar junction fractures. MATERIAL AND METHODS: This prospective study included 20 patients, mean age 43.3 years, with at least one year follow-up. All patients presented a normal neurological examination (Frankel E). Fractures were classified Magerl A (n = 19) and B (n = 1). Corporectomy/correction (aided with an endodistractor in the last nine cases) was performed with grafting and osteosynthesis. Perioperative and postoperative complications were noted. Focal kyphosis and regional angulation were noted before and after the operation and at last follow-up using the Stagnara system. RESULTS: The arthrodesis had fused at last follow-up in all patients. There were three cases of alelectasia which regressed in two months. Overall outcome showed satisfactory angular correction which was maintained at last follow-up. The gain in focal kyphosis was 13.71 degrees on average in the immediate postoperative period and persisted at last follow-up (13.31degrees). The gain in corrected regional angulation was 14 degrees in the immediate postoperative period and 14 degrees at last follow-up. The gain in focal kyphosis and regional angulation was two-fold greater with the endodistractor than with external maneuvers. DISCUSSION: The complication rate was very low. Corrections obtained were comparable with those reported in the literature and persisted over time. CONCLUSION: Bearing in mind the learning curve, there are fewer complications with the video-assisted minimally invasive approach than with classical thoracotomy or anterior surgery. This is true for perioperative and early and late postoperative complications. The correction achieved is satisfactory and lasting. A specific ancillary is essential for the reduction and for fitting the anterior graft without lost of correction. This technique combines the best results achieved with thoracotomy (Onimus) with a limited rate of complications.

[Pertrochanteric fractures: a randomized prospective study comparing dynamic screw plate and intramedullary fixation]. / Comparaison vis-plaque dynamique et ostéosynthèse intra-médullaire antérograde dans les fractures pertrochantériennes: une étude prospective randomisée.

PURPOSE OF THE STUDY: The objective of this study was to compare the dynamic hip screw (Synthes) and intramedullary fixation (Targon PF, Aesculap) for the treatment of pertrochanteric fractures in terms of stability, complications and cost effectiveness. MATERIAL AND METHODS: This prospective randomized study included 60 patients hospitalized in an emergency setting for pertrochanteric fractures between December 2003 and June 2004. All surgeons in our unit participated in the study. Two fixation systems were used: the Targon proximal femoral nail (Aesculap) and the screw-plate dynamic hip screw (Synthes). We noted: patient status (ASA classification), operative data (type of implant, duration), postoperative data (blood loss, radiographic findings, early complications), and outcome (Harris score, time to walking, mortality). All patients were assessed three months after surgery. The series included 60 patients, 14 men (23%) and 46 women (77%). The Targon PF nail was used for 34 patients and the DHS for 26. In the intramedullary fixation group mean age was 81 years (SD = 12.8, range 23-96); it was 82 years (SD 9.8, range 47-97) in the screw-plate group. The AO classification was: intramedullary fixation 31A1 (n = 11), 31A2 (n = 20), 31A3 (n = 3); screw-plate 31A1 (n = 14), 31A2 (n = 11), 31A3 (n = 1). Thirty-one fractures were stable, 29 unstable. Unstable fractures were treated with the Targon PF nail (n = 18) and the DHS screw-plate (n = 11). Stable fractures were treated with the Targon PF nail (n = 15) and the DHS screw-plate (n = 15). RESULTS: Mean operative time was 35 minutes for intramedullary nailing and 42 mintues for screw-plate fixation. Mean blood loss was 410 ml for intramedullary nailing and 325 ml for screw-plate fixation (p = 0.07). Mean hospital stay was the same (11 days) in both groups. At three months, mechanical complications involved migration of the cervical screw outside the femoral head for three Targon PF fixations and for two DHS fixations. Screw migration was favored by fracture instability and presence of osteoporosis. There were two deaths in the intramedullary nailing group and one in the screw-plate group. Time to walking was 20 days on average in the intramedullary nailing group and 25 days in the screw-plate group. The mean Harris hip score was 60 in the intramedullary group and 59 in the screw-plate group. DISCUSSION AND CONCLUSION: Data in the literature report an advantage for intramedullary nailing, particularly a mechanical advantage, for the treatment of pertrochanteric fractures. Our findings show that good results are obtained with the screw-plate fixation using the DHS with less blood loss and at a lower cost.

Intrathecal baclofen--the importance of catheter position.

In a patient receiving intrathecal baclofen injections for intractable trunk and leg spasms, positioning the subarachnoid catheter tip just caudal to the spinal segments innervating the spastic muscles enhanced the spasmolytic effect of bolus injections of intrathecal baclofen on the affected muscles. Such selective positioning of subarachnoid catheters may facilitate segmental spasmolysis with lower intrathecal doses of baclofen and provide an important alternative to relying only on ascending CSF concentration gradients of baclofen from chronic lumbar intrathecal infusion.

Intrathecal baclofen for intractable spinal spasticity--a double-blind cross-over comparison with placebo in 6 patients.

A group of six subjects with intractable spinal spasticity completed a double-blind cross-over paradigm in which they received two intrathecal bolus injections of baclofen solution five hours apart on two different days and two intrathecal bolus injections of placebo saline five hours apart on two other days. Each subject was repeatedly tested with a battery of clinical and physiological tests. In contrast to the placebo injections, the group responded to the baclofen injections with subjective and objective, clinically significant improvement in parameters of spasticity in their lower limbs, including muscle tone, frequency of spasms, hyperreflexia and passive range of joint motion. Furthermore, this improvement was maintained following thirty consecutive days of intrathecal bolus injections of baclofen at a fixed dose.

[Rapidly evolving diabetic mononeuritis multiplex. Favorable outcome after immunosuppressive treatment]. / Multinévrite diabétique d'évolution rapide. Amélioration par traitement immunosuppresseur.

A 61 year-old man with type 2 diabetes mellitus presented with an extremely rapid and aggressive mononeuritis multiplex. Four months after onset, he had severe postural hypotension and at least 6 cranial nerves and 4 somatic nerves were involved. Extensive work-up failed to discover any etiology for the neuropathy apart from diabetes. Treatment with corticosteroids, i.v. immunoglobulins and cyclosporin was followed by progressive but sustained improvement. This case and few other published ones suggest that some particularly aggressive forms of diabetic neuropathy have an immune mechanism and may be treated favorably with immunosuppressor drugs.

[Osteoblastoma of the 1st metatarsal bone. Apropos of a case]. / Ostéoblastome du premier métatarsien. A propos d'une observation.

Metatarsal localisation of osteoblastoma is rare. We report a case of a sixteen years old girl. The foot was swollen but unpainful. The plain film showed an extensive, osteolytic tumor of the whole of the first metatarsal bone. The radiological diagnosis could be discussed with an aneurysmal cyst, a chondroma, a desmoplastic fibroma, a fibrous dysplasia, an angioma. The total resection was possible without opening of the tumor and reconstruction was possible with a tibial graft. The pathological diagnosis was benign osteoblastoma. Recovery was uneventful.

[Knee arthrodesis using a customized intramedullary nail: 14 cases]. / Arthrodèse du genou par implant intra-médullaire sur mesure. A propos de 14 cas.

We report our experience with knee arthrodesis using a customized intramedullary nail implanted in 14 patients. Indications for knee arthrodesis were: recurrent prosthesis infection (n=11), post-traumatic septic arthritis (n=1), aseptic loosening of a hinge prosthesis (n=1), and nonunion (n=1). A two-stage procedure was used for the 12 patients with infected joints. Mean follow-up was 19 months. Weight bearing began during the first week after arthrodesis in 13 patients. First intention bone healing was achieved in 13 patients. Mean time to healing was three months. All patients rapidly recovered full independence. Complications were: one misinsertion of the tibial stem, one nonunion which fused after repeated grafting, and two recurrent infections (controlled chronic fistulae) which required skin flaps for cover. We have found that this customized nail is a useful method for achieving bone fusion in patients with difficult indications for arthrodesis, particularly recurrent prosthesis infection.

Arthrodesis in septic knees using a long intramedullary nail: 17 consecutive cases.

BACKGROUND: Intramedullary nailing using long or modular nails is the most reliable mean of achieving femorotibial fusion. Here, we report the operative, clinical, functional, and radiological outcomes of 17 long intramedullary nail arthodeses in patients with infection. HYPOTHESIS: Clinical and functional outcomes after long intramedullary nailing are at least as good as those obtained using other implants. MATERIALS AND METHODS: We retrospectively reevaluated 17 patients after unilateral two-stage knee arthrodesis with a long titanium intramedullary nail and autologous bone grafting. We evaluated satisfaction, leg length discrepancy, and function (Lequesne and WOMAC indices). Radiographs were obtained to assess fusion, time to fusion, and femorotibial angles. RESULTS: No cases of material failure were recorded. One or more complications occurred in seven patients. Mean limb shortening was 27.6mm. Of the 17 patients, 15 were satisfied with the procedure. The mean Lequesne index was 10.5/24 and the mean overall WOMAC score was 26/88. Fusion was achieved in 16 patients, with a mean time to fusion of 5 months. Mean femorotibial angles were 178.6° of varus and 1.9° of flexion. DISCUSSION: This simple and rapid surgical technique provides functional outcomes similar to those obtained using modular nails. The fusion rate is high. Nail extraction is simple and causes minimal damage, in contrast to modular nails. Increased attention to misalignment is needed. LEVEL OF EVIDENCE: Level IV, retrospective study.

Dorsally displaced distal radius fractures: comparative study of Py's and Kapandji's techniques.

INTRODUCTION: Within the framework of a regional clinical study, the radiographic results of Py's and Kapandji's fixation techniques for dorsally displaced distal radius fractures were compared. PATIENTS AND METHODS: A prospective randomised monocenter and multi-operator study (phase III clinical trial) comparing the Py's (isoelastic pinning) and Kapandji's (intrafocal pinning) techniques was conducted. Two comparable groups were established: the Py (P) and Kapandji (K) groups. The frontal radial tilt (FRT), sagittal radial tilt (SRT), radial length and ulnar variance were measured. Analysis of subjective and objective function was based on the range of motion according to six parameters, the DASH and Jakim scoring systems. The quality of anatomical restoration was assessed arthroscopically during pin removal at 6 postoperative weeks. RESULTS: Ninety-seven patients were included in the study with a follow-up period of 1 year. The preoperative FRT was 15.17° and SRT was -19.2°. At one-year follow-up, the FRT was 25.5° in the PY group and 22.6° in the K group (p=0.009), the SRT was 10.5° in the PY group and 6.7° in the K group (p=0.04). For fractures with postero-medial fragment and Gerard Marchand's fractures, the DASH score at last follow-up was 22 in the Py group, 42 and 32 respectively in the K group. The Jakim score was 71 in the PY group and 58 in the K group (p=0.03) for fractures with postero-medial fragment. There was no report of tendon rupture in our study. DISCUSSION: Besides the good results achieved with both pinning techniques in the treatment of distal radius fractures, this series also underlines the importance to adapt the type of fixation to the fracture pattern and patient. CONCLUSION: Pinning for treating dorsally displaced distal radius fractures appears a suitable option provided that the indications and the surgical technique for each method are respected. However, pinning is not suitable for all types of fractures. LEVEL OF EVIDENCE: Level II. Randomised prospective therapeutic study.

Low-intensity pulsed ultrasound for non-union treatment: a 14-case series evaluation.

INTRODUCTION: Non-union is presently managed exclusively by surgery, but alternative treatments are under evaluation. OBJECTIVE: To assess the benefit of external ultrasound stimulation in surgically treated lowerlimb long-bone non-union. PATIENTS AND METHODS: A retrospective series of 14 patients were treated using the Exogen(®) ultrasound stimulator (Smith & Nephew Inc., Memphis, TN, USA) as part of management of surgically treated long-bone non-union. They received 20min stimulation daily over a period of 3 months. Regular clinical and radiological follow-up checked treatment efficacy. RESULTS: The mean interval to initiation of Exogen(®) treatment after initial surgery was 361 days (range, 6, 38 months). Bone consolidation was obtained in 11 of the 14 cases (79%), and within 3 months of initiation of Exogen(®) treatment in 27% (3/11), within 6 months in 27% (3/11) and within 9 months in 46% (5/11). There were no treatment-linked complications. There was no significant correlation between interval to initiation of ultrasound treatment and bone consolidation. Associated sepsis or atrophy did not significantly impact treatment efficacy. DISCUSSION: The reference treatment strategy in non-union is surgical revision, with consolidation rates ranging from 85 to 100% according to the series. This attitude entails risk of complications, notably infection and postoperative pain. The present results were comparable to those of the literature, with 79% bone consolidation and no complications. Ultrasound stimulation proved an effective and non-invasive treatment for non-union. LEVEL OF EVIDENCE: Retrospective study, level IV.

[Arthroscopic assessment of articular fractures of distal radius osteosyntheses by percutaneous pins]. / Bilan arthroscopique des fractures articulaires du radius distal ostéosynthésées par des techniques d'embrochage percutanée.

OBJECTIVES: We studied the radiological results of percutaneous pinning in articular fractures of the distal radius. We did not, thereby, have a method of direct ligamentous and articular assessment. We realized an anatomical arthroscopic assessment at six weeks of osteosynthesis of wrists. The purpose was to study the correlation between the presence of anatomical lesions and the functional result. METHODS: Thirty-five patients presenting an articular fracture with posterior displacement were included; 30 women and five men. The mean age was 62 years. All the patients were right -handed and this was the fractured side in 18 patients. The patients had clinical and radiological follow-up at three, six, 12 weeks and one year. Surgical techniques were Py or Kapandji pinning. An arthroscopy of the wrist was carried out at six weeks from the fixation at pin removal. An assessment of ligamentous lesions and quality of articular reduction was performed. RESULTS: Twenty-eight per cent of the patients had ligamentous lesions. Nine patients presented an interfragmentary distance greater than 1mm. Two patients had an articular step as high as 2mm. CONCLUSIONS: Clinical examination did not show any correlation between the anatomical imperfections noted at the time of arthroscopy and the function of the wrist at one year postoperative, regardless of the technique used.

Shoulder hemi arthroplasty radiological and clinical outcomes at more than two years follow-up.

INTRODUCTION: Humeral head replacement is used for glenohumeral osteoarthritis in young or active patients, for conditions sparing glenoid cartilage or when glenoid implantation does not appear feasible. These surgical procedures usually give satisfactory results but there is a risk of glenoid erosion and a possible deterioration of long-term outcomes. HYPOTHESIS: There is a risk of glenoid erosion after humeral head replacement which can be radiographically measured. The importance and progression of this erosion should be evaluated to determine its clinical relevance. PATIENT AND METHODS: This is a retrospective study in 15 patients (19 shoulders) who underwent humeral head replacement between 1999 and 2006. There were 11 women and four men with an average age of 54.5 years. Etiologies were avascular necrosis (11 cases) and glenohumeral osteoarthritis (eight cases). All patients were reviewed in 2008 with more than two years follow-up. Clinical evaluation included measurements of range of motion and determination of the Constant and Murley score. In addition, the patients were asked to provide a subjective evaluation of their shoulder. Radiographic analysis included computer-assisted measurements. RESULTS: The average follow-up was 45.8 months (26-108). At one year postoperative and at the final follow-up, clinical parameters such as the Constant and Murley score (37.4/100 preoperative to 64.4/100 at final follow-up) were significantly increased. During the first year, the rate of glenoid wear was 1.03 mm/year in case of avascular necrosis and 0.27 mm/year in case of osteoarthritis (p<0.001). Glenoid depth at the final follow-up was 6.97 mm for osteoarthritis compared to 4.59 mm for avascular necrosis (p<0.01). We did not find any correlation between glenoid erosion severity and clinical results. DISCUSSION: Isolated humeral head replacement may result in glenoid erosion. The rate of progression of this erosion is clearly influenced by the etiology and therefore by the preexisting condition of the glenoid cartilage. At the average follow-up, the radiological glenoid deterioration is not correlated with pain or deterioration of clinical results. LEVEL OF EVIDENCE: Level IV. Therapeutic study.

Odontoid fractures anterior screw fixation: a continuous series of 36 cases.

INTRODUCTION: Fracture of the odontoid process represents 5 to 15% of cervical spine fractures. Anterior screw fixation is the reference technique in unstable posterior oblique or horizontal odontoid fracture. OBJECTIVE: We describe results with an original anterior screw fixation technique using a curved thoraco-lumbar pedicle awl to facilitate intra-operative reduction. PATIENTS AND METHODS: This is a retrospective study of 36 consecutive patients who underwent anterior screw fixation for odontoid process fracture. Mean age was 70.3 years. Twenty six patients had type II and 10 type III fracture on the Anderson-D'Alonzo classification. On the Roy-Camille classification, there were 34 posterior oblique fractures and two horizontal fractures. There were no anterior oblique fractures. Bony union was assessed on CT-scan at 3 months. We describe the surgical technique, which used a 4.5mm cannulated cancellous lag screw in all cases. RESULTS: Mean follow-up was 3 years (range, 4 months to 8 years). No intra-operative complications were observed. Union rate was 95% and the average time to union was 5 months (3 to 6 months). DISCUSSION: Anterior screw fixation is a common surgical treatment for posterior oblique and horizontal odontoid process fractures. We detail a reliable and reproducible intra-operative reduction maneuver to obtain a good union rate without complications. LEVEL OF EVIDENCE: Level IV. Retrospective therapeutic study.