Fractures of the dens. A multicenter study.

The treatment of fractures of the dens is often inadequate, and surgeons are divided in their opinions regarding the best surgical management of these potentially serious injuries. Because of these concerns, the Cervical Spine Research Society conducted a multicenter survey of its membership regarding the management of these fractures. Fractures of the dens can be effectively classified according to the anatomical level of the fracture, as described by Anderson and d'Alonzo. We have found that the degree of angulation and amount of displacement are also important factors. Fractures occurring at the junction of the dens with the vertebral body (Type-II fractures) were found to be the most troublesome. The initial management of these fractures with a halo device was successful in only 68 per cent; however, posterior cervical fusion was successful in 96 per cent, and that appears to be the treatment of choice. Fractures extending into the vertebral body (Type-III injuries) were found not to be as benign as has been reported. Malunion and non-union occurred in patients with this injury who were treated with an orthosis alone, and a halo device or surgery may be indicated for unstable lesions.