Clinical and radiological findings after different treatment of odontoid fractures type Anderson II and III.

ABSTRACT

PURPOSE OF THE STUDY In the period from 06/00 to 08/02, 31 patients with odontoid fractures type Anderson II and III were treated and stastically recorded. 25 patients were followed up; the progess of 24, documented in detail radiographically, were evaluated independently by a traumatologist and by a radiologist. The usual time of immobilization when treating odontoid fractures type Anderson type II and III with the halo-fixator is 12 weeks. For this 12 weeks that it is worn, objective assessment of bone healing is performed radiographically and the results critically considered in terms of the length of time that the halo-fixator should be worn and whether this duration should be altered on the basis of the clinical and radiological results obtained. MATERIALS AND METHODS: 16 patients with an odontoid fracture type Anderson type II were treated partly with a halo-fixator and partly by additional operative stabilization. 15 patients with a type III fracture were treated in a halo over 12 weeks. At the time of the accident the patients to be treated had to have conventional radiographic examination and a CT scan as well as a position check following reduction. After 4, 8 and 12 weeks radiographic and CT investigation was repeated. These findings were evaluated independently by a surgeon and a radiologist. The clinical follow-up was carried out using the VAS Score and, in addition, the general activity level before and after the accident was recorded in a similar way on the Tegner/Lysholm subjective activity score. RESULTS: In most cases, according to the CT scan, the osseous bridging decreased again between the 8th and 12th weeks, as defined by resorption zones seen during the fracture healing period. Radiological evidence of complete osseous bridging was only seen after 12 weeks in three cases. CONCLUSION: Conventional radiography does not seem to us to be the most suitable technical means to evaluate osseous healing in odontoid fractures. The CT is more reliable for this. According to our radiological results, osseous healing of different types of odontoid fractures takes more than 12 weeks. Despite of its known complications, the halo fixator is still a good instrument for the treatment of odontoid fractures.