title: Surgical treatment of nonunited fractures of the odontoid process, with special reference to occipitocervical fusion for unreducible atlantoaxial subluxation or instability.
abstract: Fifty-seven consecutive patients treated surgically for nonunited fractures of the odontoid process were reviewed. All patients presented late, exhibiting neurological deficits subsequent to nonunion. Delay in presentation was between 6 and 120 months (mean 32 months) after the original injury, due to missed diagnosis or inappropriate management. Seven patients who were reduced in traction underwent a Gallie atlantoaxial fusion. In the remaining 50 patients who were unreducible, an occipitocervical arthrodesis was performed. They were followed up for a minimum of 2 years, except one who died from postoperative respiratory failure. All patients obtained a solid bony union, including two in whom nonunion occurred following atlantoaxial fusion, and occipitocervical fusion was added as a rescue. Thirty-eight patients achieved excellent neurological recovery, nine still had some disability, five retained their neurological deficits and two reported a deterioration. In two patients, a recurrence in a traumatic episode was experienced long after a resolution. Our findings demonstrate that occipitocervical arthrodesis is preferable for unreducible subluxation or instability of atlantoaxial articulation in nonunion of odontoid fractures.
authors.affiliation: Department of Orthopaedic Surgery, Changzheng Hospital, Shanghai, China.
authors.forename: L Y
authors.initials: LY
authors.lastname: Dai
authors.forename: W
authors.initials: W
authors.lastname: Yuan
authors.forename: B
authors.initials: B
authors.lastname: Ni
authors.forename: H K
authors.initials: HK
authors.lastname: Liu
authors.forename: L S
authors.initials: LS
authors.lastname: Jia
authors.forename: D L
authors.initials: DL
authors.lastname: Zhao
authors.forename: Y K
authors.initials: YK
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D013123:Spinal Fusion; D016896:Treatment Outcome