Dataset Information

Technique of Distraction, Compression, Extension, Reduction to Reduce and Realign Old Displaced Odontoid Fracture From Posterior Approach: A Novel Technique.

ABSTRACT:

Objective

Chronic 'displaced' displaced type II fractures, though uncommon, are difficult to manage. They usually require a transoral procedure followed by a posterior instrumented fusion. We describe here, a new method to reduce the fractured displaced odontoid using a posterior cervical approach only.

Methods

Prospective and observational, n = 14 had a 'displaced and irreducible' old fracture dens causing cord compression (type I, 1; type II, 13). They underwent a novel technique to reduce the fracture. The C1 arch was first drilled and removed. The C1 lateral masses on both sides were then drilled completely and a spacer was placed between the occiput and C2 facet. Following this, an intraoperative reducing maneuver was performed, utilizing the spacer as a fulcrum, and then achieving complete reduction and realignment.

Results

All patients improved clinically (mean Nurick preoperative score: 4.07 ± 0.8; the postoperative score was 1.3 ± 0.4). The mean correction in effective canal diameter was 74.3% ± 9.5% and the mean correction in actual canal diameter was 77% ± 8.7%. Solid bone fusion was demonstrated in 12 patients with at least 1-year follow-up (follow-up range, 12-35 months; mean, 21.8 ± 9.8 months).

Conclusion

The new described modification of distraction, compression extension, and reduction seems to be effective for 'displaced' chronic fracture dens with cord compression. It avoids additional transoral surgery in these patients.

SUBMITTER: Chandra PS

PROVIDER: S-EPMC10080440 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Technique of Distraction, Compression, Extension, Reduction to Reduce and Realign Old Displaced Odontoid Fracture From Posterior Approach: A Novel Technique.

Chandra P Sarat PS Samala Raghu R Doddamani Ramesh R Verma Satish S Singh Pankaj P Chauhan Mahendra Singh MS

Neurospine 20230331 1

<h4>Objective</h4>Chronic 'displaced' displaced type II fractures, though uncommon, are difficult to manage. They usually require a transoral procedure followed by a posterior instrumented fusion. We describe here, a new method to reduce the fractured displaced odontoid using a posterior cervical approach only.<h4>Methods</h4>Prospective and observational, n = 14 had a 'displaced and irreducible' old fracture dens causing cord compression (type I, 1; type II, 13). They underwent a novel techniqu ...[more]

PMID: 37016888

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Project description:Background: Interfragmentary movements have benefits in the improvement of bone formation during distraction osteogenesis (DO). Although several clinical studies reported positive outcomes regarding the application of the cyclic distraction-compression (CDC) dynamization technique in cases with poor bone formation during DO, they are mostly anecdotal without a detailed description. The purpose of this study was to investigate the effectiveness and potential mechanism of different amplitudes and rates of the CDC technique on bone regeneration in a rat femur DO model. Methods: A total of 60 adult male Sprague-Dawley rats underwent right femoral mid-diaphysis transverse osteotomy and were randomly and evenly divided into Control (no manipulation), Group1 (CDC therapy), Group2 (CDC therapy with larger amplitude), and Group3 (CDC therapy with a slower rate) after distraction. The CDC technique was performed during the middle phase of the consolidation period according to different protocols. Animals were sacrificed after 4 and 6 weeks of consolidation. The process of bone formation was monitored by digital radiographs, and the regenerate bone was evaluated by micro-computed tomography (micro-CT), biomechanical test, and histological analysis. The serum contents of hypoxia-inducible factor (HIF)-1α and vascular endothelial growth factor (VEGF) were measured by enzyme-linked immunosorbent assay (ELISA). Results: Bone regeneration after the CDC technique was improved significantly during DO. The digital radiograph, micro-CT, histomorphological analysis, and biomechanical evaluation showed better effects regarding volume, continuity, and mechanical properties of the regenerate bone in Group2 and Group3 when compared to Group1. The angiogenic and osteogenic markers were more highly expressed in Group2 and Group3 than in Group1 according to the immunohistochemical analysis. As for ELISA, the serum contents of HIF-1α and VEGF were also increased after the CDC technique, especially in Group2 and Group3. Conclusion: The CDC dynamization technique has benefits on the improvement of bone formation during DO, and the mechanism may be due to tissue hypoxia activating the HIF pathway followed by the augmentation of osteogenic-angiogenic coupling. Better outcomes may be achieved by moderately increasing the amplitude and slowing down the rate of the CDC technique.

Dataset Information

Technique of Distraction, Compression, Extension, Reduction to Reduce and Realign Old Displaced Odontoid Fracture From Posterior Approach: A Novel Technique.

Objective

Methods

Results

Conclusion

Publications

Technique of Distraction, Compression, Extension, Reduction to Reduce and Realign Old Displaced Odontoid Fracture From Posterior Approach: A Novel Technique.

Similar Datasets

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