Markus R Konieczny1, Arnold Gstrein2, Ernst J Müller2. 1. Department of Orthopedic Surgery, University Hospital of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany. E-mail address: Markus@Konieczny.net. 2. Department of Traumatology, General Hospital Klagenfurt, Feschnigstrasse 11, 9020 Klagenfurt, Austria. E-mail address for A. Gstrein: Arnold.Gstrein@lkh-klu.at. E-mail address for E.J. Müller: Ernst.Mueller@lkh-klu.at.
Abstract
INTRODUCTION: Treatment of unstable dens fractures with posterior transarticular C1-C2 arthrodesis provides a biomechanically stable construct, even when poor bone quality is present, and a low rate of complications even in elderly patients; however, when this method of fixation is performed, cervical spine rotation is substantially reduced as compared with that associated with alternative fixation techniques. STEP 1 POSITIONING: Exact positioning of the patient and use of image intensifiers are mandatory to obtain appropriate anteroposterior and lateral views of C1 and C2. STEP 2 SURGICAL APPROACH: Use the modified technique of Magerl and Seemann, as it allows a less extensive approach to C1 and C2, and the drill can enter through two incisions at the level of T1. STEP 3 INSERTION OF SCREWS: Use smooth 2.0-mm Kirschner wires to prepare the canal for the screws, and subsequently replace them with 3.0-mm self-tapping screws. STEP 4 GALLIE FUSION: Perform a modified Gallie fusion, in addition to the transarticular screw fixation, to increase stability and osseous fusion between C1 and C2. STEP 5 WOUND CLOSURE: Perform meticulous closure of the wound to avoid wound-healing complications. RESULTS: In our original study, we treated twenty-five patients with posterior transarticular fixation.IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: Treatment of unstable dens fractures with posterior transarticular C1-C2 arthrodesis provides a biomechanically stable construct, even when poor bone quality is present, and a low rate of complications even in elderly patients; however, when this method of fixation is performed, cervical spine rotation is substantially reduced as compared with that associated with alternative fixation techniques. STEP 1 POSITIONING: Exact positioning of the patient and use of image intensifiers are mandatory to obtain appropriate anteroposterior and lateral views of C1 and C2. STEP 2 SURGICAL APPROACH: Use the modified technique of Magerl and Seemann, as it allows a less extensive approach to C1 and C2, and the drill can enter through two incisions at the level of T1. STEP 3 INSERTION OF SCREWS: Use smooth 2.0-mm Kirschner wires to prepare the canal for the screws, and subsequently replace them with 3.0-mm self-tapping screws. STEP 4 GALLIE FUSION: Perform a modified Gallie fusion, in addition to the transarticular screw fixation, to increase stability and osseous fusion between C1 and C2. STEP 5 WOUND CLOSURE: Perform meticulous closure of the wound to avoid wound-healing complications. RESULTS: In our original study, we treated twenty-five patients with posterior transarticular fixation.IndicationsContraindicationsPitfalls & Challenges.