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18-JUNE-2013 IBAA MUFLEH ABU-RUZ 28 YEARS
NONUNION OF THE ODONTOID AFTER RTA 23-JANUARY-2013.
Anamnesis
The patient came
to the clinic 14-April-2013 with Halo traction
brace after suffering RTA 23-January-2013 with
fracture odontoid with fracture of the mandible
for what surgical fixation for the mandible was
done 05-February-2013. CT-scan of the cervical
spine done 18-March-2013 showing the fracture of
the odontoid type II.
On examination: The patient is in Halo traction
and neurologically was suffering from visual
scatomas of the right eye, diplopea with paresis
of the right VI nerve. The patient was advised
to continue in Halo traction and given Somazina
and Nucleo CMP to improve the affected nerves.
The patient then came 06-May-2013 with new
CT-scan of the neck showing the same fracture of
the base of the odontoid and telling that the
diplopea resolved and the vision of the right
eye became better.
The patient then came 16-June-2013 with new
CT-scan of the neck done 16-June-2013 showing
the same fracture without signs of healing with
a gap between the fracture of the odontoid and
the body of C2 around 3 mm. It was partially
healed at the left 1/4th of the dense base. The
patient was complaining of the Halo traction and
came one time for the loose pins and he is
unable to continue wearing the device. It was
decided that it is unwise to remove the traction
device without performing fixation.
The patient was intubated
with the Halo in place. Positioning of the
patient in supine position with Gardner traction
applied. The Halo was removed. The C1 and C2 and
upper half of C3 laminae were exposed. The
spinous process of C2 was nibbled with
preservation of the lamina. Using Vertex 2
sublaminar hooks 4 mm to C1 and 6 mm to
the C2, compression with fusion of C1 and C2 was
achieved. The rods were 3.2 mm thickness and 35
mm length. The bone harvested from the spinous
process and near by bone elements was used as
bone graft between C1 and C2 laminae. Check by
C-arm.
Routine closure of the wound.
Smooth postoperative recovery.
Comments
The patient has odontoid fracture type II with
inability to heal. Fusion of C1-2 is the more
favorable option in this case.
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