Anterior Screw Fixation of Anteriorly Displaced Type III Odontoid Fracture Corrected by Transoral Digital Manipulation
A 30-year-old man was transferred to the emergency department due to neck pain by falling down. There was no neurological deficit on admission. Cervical computed tomography (CT) showed the type III odontoid fracture accompanying partial fracture of left superior articular process of the axis () and a 5.4-mm anterior displacement of the dens (). Cervical magnetic resonance imaging showed an intact transverse atlantal ligament and no spinal cord injury. Gardner-Well tongs skull traction was performed. A reduction of displaced dens was failed. We decided to perform a surgery for intraoperative reduction and stabilization. Under general anesthesia with somatosensory evoked potential and motor evoked potential monitoring, closed reduction using distraction with flexion and extension was failed. A surgical assistant attempted to compress the posterior oropharynx via the patient's mouth under simultaneous fluoroscopic visualization. A fluoroscopic image showed a reduction of displaced bone fragment (). Anterior lag screw fixation was achieved under continuous transoral digital compression, but complete reduction was not achieved (). There was no neurological abnormality intraoperatively and postoperatively. After six months, he did not complain neck pain and show a limitation of cervical rotation. Radiographs showed an osseous union, although that the posterior margins of both dens and axis body were not matched after six months (). There was no instability in dynamic flexion-extension X-rays (). After one year, the patient was lost to follow-up.