RT Journal
A1 Konieczny, Markus R.
A1 Gstrein, Arnold
A1 Müller, Ernst J.
T1 Treatment Algorithm for Dens Fractures: Non-Halo Immobilization, Anterior Screw Fixation, or Posterior Transarticular C1-C2 Fixation
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2012
FD October 3
VO 94
IS 19
SP e144 1
OP 6
DO 10.2106/JBJS.K.01616
UL http://dx.doi.org/10.2106/JBJS.K.01616
AB Background: 
  The appropriate treatment of dens fractures is unclear. We established a staged treatment protocol for dens fractures and conducted a prospective study to evaluate the outcome of treatment based on this protocol.Methods: 
  We prospectively evaluated sixty-nine consecutive patients who presented to our institution with a dens fracture. The mean duration of follow-up was 9.7 months (range, six to fifty-eight months). Fractures were categorized as stable or unstable. Stable fractures were treated by immobilization in a rigid collar. Patients seventy-five years or older with unstable fractures, patients with a neurological deficit, and patients with Anderson and D’Alonzo type-III fractures underwent posterior transarticular C1-C2 stabilization. Unstable fractures in patients younger than seventy-five years were stabilized with direct anterior screw fixation. Thirty-one patients were treated with a Philadelphia collar, twenty-five with posterior transarticular fixation, and thirteen with direct anterior screw fixation.Results: 
  Fracture-healing or solid fusion of C1-C2 was documented in sixty-eight of sixty-nine treated patients at final follow-up. The remaining patient had a stable nonunion of the dens. Secondary procedures were performed in five patients.Conclusions: 
  Our treatment algorithm based on dens fracture type, fracture stability, and patient age was associated with a high success rate. Evaluating fracture stability is crucial when considering nonoperative treatment. External stabilization with a rigid cervical collar was adequate for stable fractures of the dens and was associated with a high healing rate. Posterior transarticular screw fixation of C1-C2 was associated with a high success rate, including in elderly patients.Level of Evidence: 
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.