Document Detail


Conservative treatment of neural arch fractures of the axis: computed tomography scan and x-ray study on consolidation time.
MedLine Citation:
PMID:  21492736     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Computed tomography (CT) scan and X-ray study on consolidation time of C2 neural arch fractures treated conservatively were examined.
METHODS: A prospective study was undertaken: 28 conservatively treated fractures of the neural arch of the axis (11 hanged-man type I, 5 type II, and 12 miscellaneous fractures) were monitored during the period of orthosis by means of CT scan and plain X-rays performed on admission, and then at intervals between 2 and 120 days afterward. In patients treated with a halo vest (20 cases), a CT scan of the skull was performed to make sure that the pins were correctly positioned and to evaluate the osteolytic processes at the pin-bone interface.
RESULTS: Two patients died as a result of other severe brain or thoracoabdominal injuries, and the remaining 26 fractures healed in an average time of 109 days (range 90-120). The process of bone consolidation was documented in detail by CT, which showed how the newly formed osteofibrous tissue (iso-hypodense) progressively filled the interfragmentary space. In 2 cases of cranial pin loosening, CT demonstrated an osteolytic rim at the interface, which prompted early removal of the halo system. At clinical follow-up (mean 32 months; range 24-84), functional status was evaluated: all of the patients were neurologically intact with the exception of one, who presented with persistent paresthesias. The most frequent disturbance was cervical pain (12 cases, 46%).
CONCLUSIONS: CT with two- and three-dimensional reconstructed images has been shown to be the most reliable method for clarifying the evolution of bone consolidation and to show any osteolytic processes at the pin-bone interface during halo vest immobilization. Follow-up results of our series suggest that surgical treatment would not have improved the quality of life in these patients.
Authors:
Alessandro Ramieri; Maurizio Domenicucci; Alessandro Landi; Emanuela Rastelli; Antonino Raco
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  World neurosurgery     Volume:  75     ISSN:  1878-8750     ISO Abbreviation:  World Neurosurg     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-04-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101528275     Medline TA:  World Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  314-9     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Orthopaedic Service, Don Gnocchi Foundation of Rome, Rome, Italy.
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