A novel technique of two-hole guide tube for percutaneous anterior odontoid screw fixation.
BACKGROUND CONTEXT
Surgical stabilization is recommended for odontoid fractures with mechanical instability. Compared with C1-C2 fusion, percutaneous anterior odontoid screw fixation has the advantages of preserving C1/C2 motion and being a minimally invasive procedure. However, determining the optimal screw trajectory is often difficult. When an initial suboptimal K-wire hole is drilled, it is especially difficult to drill a second optimal K-wire trajectory because the initial hole will be entered inadvertently.


PURPOSE
To design a novel device, two-hole guide tube, to make drilling a second optimal K-wire trajectory easier, and thus, avoid unnecessary additional surgical time and reduce the likelihood of needing to change the procedure to traditional open surgery.


STUDY DESIGN
A technical report.


METHODS
Fifty-three patients with odontoid fractures were treated by percutaneous anterior odontoid screw fixation in our hospital, and the initial K-wire trajectories of 16 cases (12 men and 4 women) among the 53 patients were imperfect. The two-hole guide tube was applied for drilling the second trajectory in each of these 16 cases.


RESULTS
No complications associated with this technique occurred. Satisfactory results and good screw placement was achieved in all patients. Radiographic fusion was confirmed for 15 of 16 patients. None of the patients experienced clinical symptoms or screw loosening or breakage in this study.


CONCLUSIONS
Our novel device, two-hole guide tube, can be used to reduce the difficulty associated with redrilling an optimal K-wire trajectory if the initial trajectory is imperfect during percutaneous anterior odontoid screw fixation. Moreover, by referring to the initial misplaced K-wire, a more accurate trajectory for the second K-wire can be achieved.
['Wu|Ai-Min|AM|', 'Wang|Xiang-Yang|XY|', 'Xia|Dong-Dong|DD|', 'Luo|Peng|P|', 'Xu|Hua-Zi|HZ|', 'Chi|Yong-Long|YL|']
D000328:Adult D001863:Bone Screws D001864:Bone Wires D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009809:Odontoid Process D019637:Orthopedic Procedures D016103:Spinal Fractures
Guide tube Percutaneous Odontoid fracture Minimally invasive Trajectory K-wire Technique note