The Journal of Bone and Joint Surgery, Vol 67, Issue 9 1340-1348, Copyright © 1985 by Journal of Bone and Joint Surgery, Inc
Fractures of the dens. A multicenter study
CR Clark and AA White
The treatment of fractures of the dens is often inadequate, and surgeons
are divided in their opinions regarding the best surgical management of
these potentially serious injuries. Because of these concerns, the Cervical
Spine Research Society conducted a multicenter survey of its membership
regarding the management of these fractures. Fractures of the dens can be
effectively classified according to the anatomical level of the fracture,
as described by Anderson and d'Alonzo. We have found that the degree of
angulation and amount of displacement are also important factors. Fractures
occurring at the junction of the dens with the vertebral body (Type-II
fractures) were found to be the most troublesome. The initial management of
these fractures with a halo device was successful in only 68 per cent;
however, posterior cervical fusion was successful in 96 per cent, and that
appears to be the treatment of choice. Fractures extending into the
vertebral body (Type-III injuries) were found not to be as benign as has
been reported. Malunion and non-union occurred in patients with this injury
who were treated with an orthosis alone, and a halo device or surgery may
be indicated for unstable lesions.
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