C1-C2 Transarticular Anterior Fixation for the Treatment of Atlantoaxial Traumatic Dislocation: A Clinical Case.

Fractures of the odontoid apophysis are one of the most frequent lesions in the elderly population, and an increasingly preponderant problem with the progressive aging of the world population. In the present work, we report a clinical case of an 88-year-old male patient who suffered a fall resulting in a type-II fracture of the odontoid apophysis on the Anderson-D'Alonzo classification. Given the age and comorbidities of the patient, we decided to perform osteosynthesis of the fracture through anterior fixation with a transarticular screw in combination with fixation with an odontoid screw. This technique enables the necessary stability for the consolidation of Anderson-D'Alonzo's type II odontoid apophysis fracture, with the advantage of the lower levels of dissection of the cervical extensor musculature and hemorrhage resulting from this aggression when compared with the posterior approach; moreover, it is a readily-available technique that yields clear benefits in the treatment of this pathology in the geriatric population.

Treatment of Two-column Acetabular Fractures by Double Extrapelvic Approach: Three Clinical Cases.

Fractures of two columns of the acetabulum according to the Letournel classification are among the most common in frequency, indication and surgical complexity. These are mainly the result of lateral compression mechanisms and are characterized by originating a disconnected acetabulum from the axial skeleton. Its surgical treatment may include: isolated anterior or posterior approach; combined, at the same surgical time or not; or broad approaches. The authors present another surgical option with association of the Kocher-Langenbeck pathway with the iliac crest approach simultaneously and in the same positioning (lateral decubitus) based on the first three clinical cases performed and their clinical and imaging results. In addition to the presentation of the cases, a description of the three characteristic fragments of this type of acetabular fractures, the approach pathway, and the reduction sequence performed are made. From the results obtained and the associated advantages, the authors believe that the addition of the iliac crest approach to the Kocher-Langenbeck pathway may be a very attractive option to consider in the surgical treatment of properly selected fractures of two columns of the acetabula.

Anatomical reconstruction of complete burst vertebral fracture case report-combined reduction methods and armed kyphoplasty with stents filled with bone graft.

Background: Minimally invasive techniques used to augment the fractured vertebral body have acquired popularity thanks to their capacity to stabilize the anterior spine via the percutaneous posterior pathway. Case Description: We present a clinical case of a 50-year-old male patient with a traumatic complete burst fracture of L1 vertebral body treated by L1 laminectomy, percutaneous pedicle instrumentation D11-D12-L2-L3 and indirect fracture reduction, followed by direct reduction by armed kyphoplasty with stents filled with bone graft. We describe the details of the surgical technique, as well as clinical and imaging outcomes. After 3-year follow-up, the patient is practically asymptomatic and control computed tomography demonstrates vertebral body fracture healing and maintenance of the vertebral heights recorded in the immediate postoperative period, without signs of loosening, migration or failure of intrasomatic stents or pedicle screws, as well as of bone graft resorption, which indicates its osseointegration and healing. We discuss the concepts of indirect and direct reduction and the rationale for anatomical vertebral restoration and for the use of intrasomatic bone graft. Conclusions: We present a detailed description of a promising surgical technique combining indirect and direct reduction and vertebral body interior replacement with stents filled with bone graft, as a treatment that allows for a complete burst fracture to be anatomically restored by a posterior and minimally invasive approach. Also, we demonstrate a fast and full recovery, avoiding the morbidity and risk of serious complications of anterior approaches. Nevertheless, long-term prospective studies are necessary so as to prove the effectiveness and assets of this surgical option versus other common techniques in complete burst fractures.

Treatment of Two-column Acetabular Fractures by Double Extrapelvic Approach: Three Clinical Cases / Tratamento de fraturas acetabulares de duas colunas por dupla via extrapélvica: Três casos clínicos

Abstract Fractures of two columns of the acetabulum according to the Letournel classification are among the most common in frequency, indication and surgical complexity. These are mainly the result of lateral compression mechanisms and are characterized by originating a disconnected acetabulum from the axial skeleton. Its surgical treatment may include: isolated anterior or posterior approach; combined, at the same surgical time or not; or broad approaches. The authors present another surgical option with association of the Kocher-Langenbeck pathway with the iliac crest approach simultaneously and in the same positioning (lateral decubitus) based on the first three clinical cases performed and their clinical and imaging results. In addition to the presentation of the cases, a description of the three characteristic fragments of this type of acetabular fractures, the approach pathway, and the reduction sequence performed are made. From the results obtained and the associated advantages, the authors believe that the addition of the iliac crest approach to the Kocher-Langenbeck pathway may be a very attractive option to consider in the surgical treatment of properly selected fractures of two columns of the acetabula.

Resumo As fraturas de duas colunas do acetábulo segundo a classificação de Letournel são das mais comuns em frequência, indicação e complexidade cirúrgica. Estas resultam essencialmente de mecanismos de compressão lateral e caracterizam-se por originarem um acetábulo desconectado do esqueleto axial. O seu tratamento cirúrgico pode incluir: abordagem anterior ou posterior isolada; combinadas, no mesmo tempo cirúrgico ou não; ou abordagens alargadas. Os autores apresentam outra opção cirúrgica com associação de via de Kocher-Langenbeck e abordagem da crista ilíaca simultânea e no mesmo posicionamento (decúbito lateral) com base nos três primeiros casos clínicos realizados e seus resultados clínicos e imagiológicos. Para além da apresentação dos casos, é feita uma descrição dos três fragmentos característicos deste tipo de fraturas acetabulares, da via de abordagem e da sequência de redução realizada. Pelos resultados obtidos e vantagens associadas, os autores acreditam que a adição da abordagem da crista ilíaca à via de Kocher-Langenbeck pode ser uma opção muito atrativa a ter em conta no tratamento cirúrgico de fraturas de duas colunas do acetábulo devidamente selecionadas.