BIVECTOR TRACTION FOR UNSTABLE CERVICAL-SPINE FRACTURES - A DESCRIPTION OF ITS APPLICATION AND PRELIMINARY-RESULTS

The management of acute, displaced odontoid fractures requires the res toration of sagittal alignment and ri,aid external or internal immobil ization to prevent late instability and achieve union. This report int roduces a new traction technique for the reduction of posteriorly disp laced type 2 odontoid fractures. Seven patients with traumatic injurie s to the dens were placed in bivector traction for an awake closed red uction. Sagittal alignment was restored and maintained in all patients with no neurologic deterioration or traction-related complications du ring an average of 11 days (range, 2-28 days) in traction. The overall sagittal alignment corrected from an initial average of 12.2 mm (rang e, 5-22 mm) of posterior displacement to an average of 1.1 mm (range, 0-3 mm) at the completion of reduction. Only one patient had residual angulation, which measured 5 degrees. Three patients achieved an osseo us union and the remaining four required a posterior C1-C2 fusion for nonunion. Although operative stabilization may be the preferred approa ch in this patient population and injury pattern, we conclude that biv ector traction is a safe and effective technique for the initial manag ement of posteriorly displaced odontoid fractures. In addition, its ro le can be expanded to the closed reduction of lower cervical spine fra ctures in patients with fu;ed flexion deformities secondary to ankylos ing spondylitis or disseminated intraosseous segmental hyperostosis.