We have reviewed 81 patients with fractures of the odontoid process treated
between May 1983 and July 1997, by anterior screw fixation.
There were 29 patients with Anderson and D'Alonzo type-II fractures and 52
with type III. Roy-CamiIle's classification identified the direction and in
stability of the fracture. Operative fixation was carried out on 48 men and
33 women with a mean age of 57 years. Associated injuries of the cervical
spine were present in 15 patients, neurological signs in 13, and 18 had an
Injury Severity Score of mure than 15, Nine patients died and 11 were lost
to follow-up. Of 61 patients, 56 (92%) achieved bony union at an average of
14.1 weeks. Two patients required a secondary posterior fusion after failu
re of the index operation. A full range of movement was restored in 43 pati
ents; only six had a limitation of movement greater than 25%.
We conclude that anterior screw fixation is effective and practicable in th
e treatment of fractures of the dens.