Screw fixation of odontoid fractures and nonunions.

Surgical treatment of odontoid fractures has usually been carried out by C1-2 arthrodesis rather than by fracture fixation. An alternative treatment of compression screw fixation was used to treat selected acute odontoid fractures and nonunions. Ten patients were operated on. A variety of lag-screw types were used to compress and secure the fracture. Screw placement was considered excellent in five cases; in four, the screw tip protruded through the posterosuperior cortex of the dens by 1-3 mm. One patient died as a result of multiple injuries 2 days after surgery. In all other cases, including four cases of odontoid pseudarthroses, the fractures achieved solid union. It was concluded that screw fixation can be used for the successful treatment of selected odontoid fractures and nonunions.