What is the role of single screw fixation in the treatment of C2 fractures?

Updated: Nov 21, 2018
  • Author: Igor Boyarsky, DO, FACEP, FAAEM; Chief Editor: Jeffrey A Goldstein, MD  more...
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Nonunion, malunion, and pseudarthrosis formation are potential major complications. Factors affecting this are amount and position of displacement, degree of angulation, ability to obtain and hold a reduced fracture, age of the patient, and tolerance to halo immobilization. However, some reports have demonstrated nonunion rates approaching 80% in certain subsets of patients. Shilpakar et al looked at all treatment options and associated rates of complications. [16]  On the basis of a meta-analysis of previously published studies, they concluded that type II fractures are best managed with odontoid screw fixation.

Anterior odontoid single screw fixation is noted to preserve normal rotation at C1/C2, provide immediate stability, and obviate the need for postoperative halo immobilization. Furthermore, rates of malunion, nonunion, and pseudarthrosis formation are very low. There are limitations to this approach, namely, the age of the fracture and the patient's body habitus. If the fracture is older than 4 weeks or if the patient possesses a short neck and barrel-shaped chest, consider an alternative treatment approach, such as transarticular screw fixation or Brooks sublaminar fusion.

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