Treatment of dens fracture in adults: A report of thirty-two cases.

Thirty-two adult patients with dens fractures (30 type II and 2 type III) were treated from 1983 to 2002 at the authors' institutions. The age of the patients ranged from 23 to 58 years. The postoperative follow-up period ranged from 1 to 10 years. The objective of this retrospective study was to evaluate the effectiveness of the osteosynthesis after screw fixation and postoperative bracing. In the 32 cases, 19 patients underwent single screw and 13 underwent double screw fixation. Postoperatively, light head halter traction was applied with the patients in bed for 1 to 4 weeks followed by a halo-vest for 8 to 14 weeks. Fractures healed in 9 weeks on average. There were no cases of delayed union. The overall results were excellent in 26 cases (81.3%), good in 5 (15.6%), and fair in 1 (3.1%) patient (who had a type Il fracture). There were no difference in dens union patterns between those receiving one-screw and two-screw fixation, and there were no complications during or after the operative procedure. Postoperatively there were no restriction of motion in the neck and no residual neck pain. Direct osteosynthesis of the fractured dens with screws is an effective procedure for unstable type II and III fracture of the dens. Postoperative external immobilization with a cervical brace seems to be an important contributing factor to the equal fusion rates in both groups of patients.