Acrylic fixation in displaced dens fractures

Posterior acrylic surgical fixation of odontoid fractures

Fourteen cases of odontoid fractures had, as primary treatment, a posterior surgical fixation (C1 + C2 + C3 and occiput in some cases) by means of acrylate and stainless steel wires, without waiting for the unpredictable final results of external systems of stabilization. The youngest patient was 20 years old, the oldest 84 years old. No immediate or late neurological complications occurred (follow-up: one year to ten years). All the patients were mobilized early without external fixation. Union of the dens took place in eleven cases, and good stabilization in the remainder. Thirteen patients recovered, one improved. Posterior acrylic fixation is the treatment of choice in cases of odontoid fracture, particularly in elderly patients in whom a solid union rarely is obtained.

Fracture of the dens in the aged

Six elderly patients with fractures through the base of the dens are presented. Early posterior fusion with wire and acrylic is recommended after reduction and maintenance of alignment with skeletal traction and treatment of coexistent injuries and illnesses. Uncommon problems and associated injuries complicating treatment in this group of patients are discussed. Some patients in this age group may best be treated with a collar because of concurrent cardiopulmonary disease.