Temporary spanning internal fixation for management of complex upper cervical spine fractures

Abstract

Introduction: Fractures of the upper cervical spine are often but not always amenable to either internal fixation or conservative management using a rigid cervical collar. For all other fractures in this area, management with a halo-vest orthosis is indicated, but it also has limitations. Here, we present an operative alternative to the halo-vest orthosis that provides more secure stability and less complications. Methods: Three patients presented to our hospital with atypical fractures of C1 and C2 and were given the choice of either a halo-vest orthosis or secure internal fixation without fusion and accepted the latter. Internal fixation without fusion from occiput to the subaxial spine was performed for all three and then removed-6 months later -after radiologic confirmation of healing. Results: All three patients underwent the procedure successfully and achieved and maintained acceptable alignment. Range of motion was preserved, and no intermediate-term issues were observed. Conclusion: Spanning internal fixation provides a safe and effective technique in the management of complex upper cervical spine injuries without the drawbacks of using a halo-vest orthosis.

Pan‐carpal arthrodesis as a treatment for distal radial fracture in a pony

“…Eventually, the horse maintained partial carpal flexion; therefore, although not planned, the repair resulted in temporary pan‐carpal trans‐articular stabilisation with gradual implant removal. Temporary trans‐articular stabilisation is reported as treatment of ligamentous and osseous pathologies of the carpus and foot in humans (Abbasian et al, 2015) as well as in cervical spine fractures or instability in children (AlSaleh et al, 2021; Kelley et al, 2017), and as temporary stabilisation of shoulder luxation in dogs (Post et al, 2008). In both species, cartilage debridement was not performed; therefore, bony union was not achieved and removal of the implants after recovery of the affected tissue results in normal joint function.…”

Halo vest fixation effectively maintains cervical alignment through intraoperative repositioning in patients with cervical spine instability

“…The halo vest consists of a ring that is placed around the patient's head and attached to a vest worn over the chest, enabling definitive external stability from the skull to the mid-lower cervical spine. It helps prevent further insult to the cervical cord and allows for improved healing of cervical instability [ 6 , 7 ].…”