Guidewire Breakage: An Unusual Complication of Anterior Odontoid Cannulated Screw Fixation

Abstract

The preferred treatment of a type II odontoid fracture is anterior odontoid screw fixation to preserve the cervical spine range of movement. This case report describes an unusual complication of guidewire breakage during anterior odontoid cannulated screw fixation for a 52-year-old patient who presented with a type II odontoid fracture after a motor vehicle accident. The distal segment of the guidewire was bent over the tip of the cannulated odontoid screw and broke off during guidewire withdrawal. The three months follow-up computed tomography examination of the cervical spine showed acceptable screw placement, good odontoid process alignment with incomplete fusion, and no migration of the fractured segment of the guidewire. It is recommended that the guidewire be withdrawn once the cannulated screw is passed through the fractured site into the odontoid process and a new guidewire be used in each surgical procedure instead of been reused to avoid metal stress fatigue that can result in easy breakage.

Anterior Screw Fixation for Odontoid Fracture Using the Direct Approach at the C2-C3 Level: Case Report and Literature Review

“…Therefore, when a skin incision is made at the lower cervical level (C4-C5 or C5-C6), the required exposure and the relatively blind passage of the screw may be the greatest sources of complications [9]. According to Literature review [4, 10,11,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38], about 80% of authors used these levels as entry point to achieve a work corridor to the odontoid fracture (Table 1). Another 20% of authors reported a higher level of cervical approach (C2-C3 or C3-C4).…”

Intra-operative K-wire breakage during odontoid screw fixation

“…The neurological examination was within normal limits. In the literature, there has been only one report documenting similar problem [3] where no attempt was made to retrieve the broken wire citing similar apprehensions. Awake intubation was done with nonreinforced tube using fi beroptic bronchoscope to prevent any motion at the neck.…”

Fracture and dislodgment of a guidewire retrieved by a Solitaire AB neurovascular remodeling device

“…This method can effectively and safely treat the disease (Shammas et al, 2008). However, if a guidewire catheter is fractured and dislodged during the operation, many serious complications may occur, such as displacement embolism, bleeding, and vascular dissection (Orief et al, 2011). In particular cases, these complications may be lifethreatening.…”