Anterior screw fixation of odontoid fractures

BACKGROUND Anterior screw fixation is the best treatment for odontoid fract ures when the fracture line is horizontal or oblique downward and backward, as it preserves atlantoaxial mobility, especially axial rotation. Some det ails regarding patient positioning and operative technique need to be stres sed to obtain the best results and avoid complications. METHODS Between 1989 and 1997, we treated 17 cases of odontoid fracture by anterior screw fixation. Only two patients presented with motor neurologic deficit. Fracture line was horizontal in 3 cases and oblique downward and b ackward in 14 cases. RESULTS Adequate reduction and fixation was obtained in all cases except on e, where posterior displacement of the screw occurred without neurologic co mplications. Functional result was satisfactory in all cases except two, wh ere we noted significant limitation of cervical rotation. CONCLUSION Successful anterior screw fixation gives the best anatomical and functional results for odontoid fractures. Correct installation is very im portant for operative success. (C) 1999 by Elsevier Science Inc.