ORIGINAL
Introdução: Fraturas do odontoide tipo II são as mais comuns dessa região e alto risco de não-consolidação com tratamento conservador. A fixação anterior do odontoide com parafuso (FAOP) é o padrão cirúrgico aceito, mas limitações de recursos em países em desenvolvimento frequentemente impedem acesso à neuronavegação ou tomografia intraoperatória. Apresentamos a experiência com a técnica “free-hand” para FAOP usando orientação fluoroscópica mínima. Métodos: Revisão retrospectiva de dez pacientes consecutivos submetidos à FAOP com parafuso único para fraturas tipo II (janeiro/2023 a dezembro/2024) em unidade terciária de neurocirurgia no Deccan, Índia. Todos os procedimentos utilizaram técnica free-hand sob fluoroscopia convencional com arco em C, sem neuronavegação ou O-arm. Resultados: Esta coorte incluiu oito homens e duas mulheres, com idade média de 32,8 anos (20-52 anos). Acidentes de trânsito causaram 70% das lesões. Oito pacientes (80%) apresentaram desfechos excelentes no pós-operatório imediato. Dois com contusão medular não obtiveram melhora neurológica imediata, mas alcançaram ASIA grau D em três meses. Nove pacientes (90%) obtiveram consolidação óssea. Um mau posicionamento do parafuso exigiu cirurgia de revisão. Conclusão: A FAOP free-hand é segura, viável e eficaz mesmo sem imagem intraoperatória avançada, exigindo planejamento pré-operatório meticuloso, posicionamento preciso do paciente e profundo conhecimento da anatomia cirúrgica.
Introduction: Type II odontoid fractures account for most odontoid injuries and carry a high risk of non-union with conservative treatment. Anterior odontoid screw fixation (AOSF) is the accepted surgical standard, but resource constraints in developing countries often preclude neuronavigation or intraoperative CT. We report our experience with the free-hand technique using minimal fluoroscopic guidance. Methods: We retrospectively reviewed ten consecutive patients who underwent single-screw AOSF for Type II fractures between January 2023 and December 2024 at a tertiary neurosurgical unit in Deccan India. All procedures used the free-hand technique under conventional C-arm fluoroscopy, without neuronavigation or O-arm assistance. Results: The cohort included eight males and two females, with a mean age of 32.8 years (range 20–52). Road traffic accidents caused 70% of injuries. Eight patients (80%) had excellent immediate postoperative outcomes. Two patients with cord contusion showed no immediate neurological improvement but reached ASIA Grade D by three months. Bony union was achieved in nine patients (90%). One screw malposition required revision surgery. Conclusion: Free-hand AOSF is safe, feasible, and effective even where advanced intraoperative imaging is unavailable. It demands meticulous preoperative planning, precise patient positioning, and thorough knowledge of surgical anatomy.
1. Anderson LD, D’Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am. 1974;56(8):1663-74. https://doi. org/10.2106/00004623-197456080-00017. PMid:4434035.
2. Hadley MN, Browner CM, Liu SS, Sonntag VKH. New subtype of acute odontoid fractures (Type IIA). Neurosurgery. 1989;22(1):67-71. https://doi.org/10.1227/00006123-19880100000010. PMid:3344089.
3. Fountas KN, Kapsalaki EZ, Karampelas I, et al. Results of long-term follow-up in patients undergoing anterior screw fixation for type II and rostral type III odontoid fractures. Spine. 2005;30(6):661-9. https://doi. org/10.1097/01.brs.0000155415.89974.d3. PMid:15770182.
4. Nakanishi T. Internal fixation of the odontoid fracture. Central Japan Journal of Orthopaedic and Traumatological Surgery. 1980;23:399-406.
5. Böhler J. Anterior stabilization for acute fractures and non-unions of the dens. J Bone Joint Surg Am. 1982;64(1):18-27. https://doi. org/10.2106/00004623-198264010-00004. PMid:7033229.
6. Platzer P, Thalhammer G, Oberleitner G, Schuster R, Vecsei V, Gaebler C. Surgical treatment of dens fractures in elderly patients. J Bone Joint Surg Am. 2007;89(8):1716-22. https://doi.org/10.2106/00004623200708000-00007. PMid:17671009.
7. Goel A. Treatment of odontoid fractures. Neurol India. 2015;63(1):7-8. https://doi.org/10.4103/0028-3886.152657. PMid:25751462.
8. Moon MS, Moon JL, Sun DH, Moon YW. Treatment of dens fracture in adults: A report of thirty-two cases. Bull Hosp Jt Dis. 2006;63(3–4):108-12. PMid:16878829.
9. Sawarkar D, Singh P, Siddique S, et al. Surgical management of odontoid fracture at a level one trauma center: A single-center surgical series of 142 cases. Neurol India. 2015;63(1):40-8. https://doi. org/10.4103/0028-3886.152633. PMid:25751468.
10. Chiba K, Fujimura Y, Toyama Y, Fujii E, Nakanishi T, Hirabayashi K. Treatment protocol for fractures of the odontoid process. J Spinal Disord. 1996;9(4):267-76. https://doi.org/10.1097/00002517-19960800000001. PMid:8877952.
1Department of Neurosurgery, Osmania Medical College and Osmania General Hospital, Hyderabad, Telangana, India
Received Jul 10, 2026
Corrected Jul 30, 2026
Accepted Aug 4, 2026
