Aims. In UK there are around 76,000 hip fractures occur each year 10% to 15% of which are undisplaced intracapsular. There is considerable debate whether internal fixation is the most appropriate treatment for undisplaced fractures in older patients. This study describes cannulated hip screws survivorship analysis for patients aged ≥ 60 years with undisplaced intra-capsular fractures. Methods. This was a retrospective cohort study of consecutive patients aged ≥ 60 years who had cannulated screws fixation for Garden I and II fractures in a teaching hospital between March 2013 and March 2016. The primary outcome was further same-side hip surgery. Descriptive statistics were used and Kaplan-Meier estimates calculated for implant survival. Results. A total of 114 operations were performed on 112 patients with a mean age of 80.2 years (SD 8.9). The 30-day and one-year mortality were 1% (n = 1) and 13% (n = 15), respectively. Median follow-up was 6.6 years (interquartile range 6.0 to 7.3). Kaplan-Meier estimates showed a survivorship of 95% at one year and 90% at five years (95% confidence interval 84% to 95%) for cannulated screws. Nine patients underwent further hip surgery: four revision to total hip arthroplasty, one revision to hemiarthroplasty, three removals of screws, and one haematoma washout. Posterior tilt was assessable in 106 patients; subsequent surgery was required in two of the six patients identified with a posterior angle > 20° (p = 0.035 vs angle < 20°). Of the 100 patients with angle < 20°, five-year survivorship was 91%, with seven patients requiring further surgery. Conclusion. This study of cannulated hip screw fixation for undisplaced fractures in patients aged ≥ 60 years reveals a construct survivorship without further operation of 90% at five years. Cannulated screws can be considered a safe reliable treatment option for Garden I and II fractures. Caution should be taken if posterior tilt angle on lateral view exceeds 20°, due to a higher failure rate and reoperation, and considered for similar management to Garden III and IV injuries. Cite this article: Bone Jt Open 2022;3(3):182–188

Purpose of Study. Bicondylar tibial plateau fractures are serious injuries to a major weight bearing joint. These injuries are often associated with severe soft tissue injuries that complicate the surgical management. This retrospective study evaluates the management of these high-energy injuries with the use of limited open reduction and fine wire circular external fixation. Methods. Between July 2008 and June 2012, 54 consecutive patients (19 females and 35 males) with high-energy tibial plateau fractures were treated at our tertiary level government hospital. All patients were treated with limited open reduction, and cannulated screw fixation combined with fine wire circular external fixators as the definitive management. The records of these patients were reviewed. Results. Forty-six patients met the inclusion and exclusion criteria. Thirty-six patients had Schatzker type-VI and ten patients had Schatzker type-V fractures. All fractures united without loss of operative reduction. No wound complications, osteomyelitis or septic arthritis occurred. Average Knee Society Clinical Rating Score was 81.6, translating to good clinical results. Minor pin tract infection was the most common complication encountered. Conclusion. Fine wire circular external fixation combined with limited open reduction and cannulated screw fixation consistently produced good functional results without serious complications. NO DISCLOSURES

Objective: To evaluate the results of cannulated screw fixation for subcapital neck of femur fractures in our unit. Materials and Methods: 104 patients underwent the above procedure in our unit over a two year period (Jan 2006 – Dec 2007). The case notes and xrays of these patients were reviewed retrospectively. The age group varied between 31 and 100 years. Results: There was 20% incidence of complications. There were 9 cases of AVN and 10 cases of screws backing out and I case of subtrochanteric fracture. Of the 9 cases of AVN 3 were below 73 years of age and the rest had a mean age of 90.3 years. Conclusion: There is a high incidence of AVN in geriatric group requiring further surgery and cannulated screws fixation is not the optimal choice in geriatric group for varied reasons. Further review is to be carried out looking for the specific reasons of failure

The majority of pediatric proximal humerus fractures are successfully treated non-operatively. Significantly displaced fractures have traditionally been treated surgically with percutaneous pinning. This review of twenty-three surgically treated patients demonstrates a high rate of infection associated with percutaneous pinning. The technique of cannulated screw fixation offers a safe surgical alternative for the treatment of these fractures in the adolescent population. To compare the results of percutaneous pinning to cannulated screw fixation for the treatment of pediatric proximal humerus fractures. A high complication rate, including pin tract infection and loss of reduction, was observed in the percutaneous pinning group. Given the rigid fixation afforded by cannulated screws and the minimal morbidity associated with proximal humeral physeal arrest in the older adolescent, this technique offers a safe alternative for the treatment of proximal humerus fractures. Average age was 13.0 years for the pinning group and 14.7 years for the cannulated screw group. Regardless of fixation technique, all fractures healed completely with no difference in rates of physeal closure. Significant pin tract drainage was encountered in six of twenty patients treated with pinning: Two with Staphylococcus Aureus infection and one deep infection requiring surgical debridement. Loss of reduction and pin migration was noted in a seventh patient. The only complication observed in the cannulated screw group was a transient axial nerve paresthesia. There were no significant differences in operative time, rate of open reduction, or length of hospitalization (p> 0.05). Twenty-three pediatric proximal humerus fractures treated operatively over a seven-year period were followed clinically and radiographically. Thirty percent of the patients treated with pinning developed pin tract infections. Similar to femoral external fixation pins, proximal humeral pins also cross a large muscle group that may result in pin micro-motion. This may create persistent drainage that ultimately leads to infection

Intracapsular neck of femur fractures may be treated with fixation or arthroplasty, depending on fracture characteristics and patient factors. Two common methods of fixation are the sliding hip screw, with or without a de-rotation screw, and cannulated screws. Each has its merits, and to date there is controversy around which method is superior, with either method thought to risk avascular necrosis of the femoral head (AVN) rates in the region of 10–20%. Fixation with cannulated screws may be performed in various ways, with current paucity of evidence to show an optimum technique. There are a multitude of factors which are likely to affect patient outcomes: technique, screw configuration, fracture characteristics and patient factors. We present a retrospective case series analysis of 65 patients who underwent cannulated screw fixation of a hip fracture. Electronic operative records were searched from July 2014 until July 2019 for all patients with a neck of femur fracture fixed with cannulated screws: 68 were found. Three patients were excluded on the basis of them having a pathological fracture secondary to malignancy, cases were followed up for 2 years post-operatively. Electronic patient records and X-rays were reviewed for all included patients. All X-rays were examined by each team member twice, with a time interval of two weeks to improve inter-observer reliability. 65 patients were included with 2:1 female to male ratio and average age of 72 years. 36 patients sustained displaced fractures and 29 undisplaced. Ten patients sustained a high-energy injury, none of which developed AVN. Average time to surgery was 40 hours and 57 patients mobilised on day one post-operatively. All cases used either 7 or 7.3mm partially threaded screws in the following configurations: 2 in triangle apex superior, 39 triangle apex inferior, 22 rhomboid and 2 other, with 9 cases using washers. All reductions were performed closed. Five (8%) of our patients were lost to follow-up as they moved out of area, 48 (74%) had no surgical complications, seven (11%) had mild complications, three (5%) moderate and two (3%) developed AVN. Both of these sustained displaced fractures with low mechanism of injury, were female, ASA 2 and both ex-smokers. One received three screws in apex inferior configuration and one rhomboid, neither fixed with washers. Our AVN rate following intracapsular hip fracture fixation with cannulated screws is much lower than widely accepted. This study is under-powered to comment on factors which may contribute to the development of AVN. However, we can confidently say that our practice has led to low rates of AVN. This may be due to our method of fixation; we use three screws in an apex inferior triangle or four screws in a rhomboid, our consultant-led operations, closed reduction of all fractures, or our operative technique. We pass a short thread cannulated screw across the least comminuted aspect of the fracture first in order to achieve compression, followed by two or three more screws (depending on individual anatomy) to form a stable construct. Our series shows that fixation of intracapsular hip fractures with cannulated screws as we have outlined remains an excellent option. Patients retain their native hip, have a low rate of AVN, and avoid the risks of open reduction

Introduction. Management of the sequelae of arthritis of the hip joint has changed over time. Total joint replacement has gained popularity due to retained mobility and stability. In the high demand paediatric and adolescent population problems are encountered with longevity of the procedure. Hip arthrodesis is a useful alternative procedure that sacrifices mobility of the joint to achieve pain relief and restores function. Several surgical techniques have been described to achieve hip fusion. We describe a technique that achieves concentric bone surfaces with hip resurfacing reamers. Maximum bone is preserved to maintain leg length. Trans-articular compression is achieved with cannulated screw fixation. Subtrochanteric de-functioning osteotomy completes the procedure to protect the fusion site and control the position of the limb. Our optimal position of fusion was 30 degrees of flexion, neutral to 5 degrees of abduction and neutral to 10 degrees of external rotation. Methods. Fourteen patients (8 female) treated by hip arthrodesis over a two-year period are reviewed in terms of clinical and radiological outcome in the short term. Their mean age at hip fusion was 11 years (6–18). The etiology included TB (6 cases), staphylococcal infection (2), non-specific arthritis (3), Perthe's (1), chondrolysis (1) and avascular necrosis following trauma (1). Results. Fusion was achieved in 12/14 patients. All patients in whom fusion was achieved had relief of pain and returned to their normal activities. Conclusion. We believe hip arthrodesis performed in the correct patient is a good procedure to preserve function and relieve pain. The procedure is technically demanding and careful follow-up to ensure optimal positioning and solid fusion is essential to ensure good results. NO DISCLOSURES

Stickler’s syndrome, also called Hereditary Progressive Arthro-Ophthalmopathy, is an autosomal dominant connective tissue disorder with strong expressivity, characterised by ocular, orofacial, skeletal, cardiac, and auditory features. We describe a case of valgus slipped capital femoral epiphysis in a 13 year-old boy with Stickler’s syndrome. He presented at routine rheumatology clinic follow-up with a 1-month history of progressively worsening right hip pain, which radiated to the knee. He underwent insitu cannulated screw fixation of the right slipped capital femoral epiphysis. Joint pains are a common manifestation in Stickler’s syndrome and this might delay the diagnosis of slipped capital femoral epiphysis. Valgus slipped capital femoral epiphysis is a rare entity. Obesity and the increased femoral anteversion are predisposing factors. Insitu fixation with a single cannulated screw is the treatment of choice

Our objective is to show the results of the unstable slipped capital femoral epiphysis treatment with reduction and threaded screw fixation. A retrospective analysis of 21 patients (13 boys and 8 girls) with unstable slipped capital femoral epiphysis was performed between 1993 and 1998. The right hip was involved in 13 patients and the left hip in 8. The patients presented acute pain and functional difficulties. The diagnoses were based on the clinical presentation, neutral and Lowestein hip x-rays. The treatment consisted on gentle manipulative reduction of the unstable slip (flexion and internal rotation), threaded cannulated screw fixation on orthopaedic table and image intensifier control. Results showed 2 avascular necrosis, 2 bone shortening, 3 limited range of motion. The rest showed satisfactory clinical results in the short term

Background. Despite studies into patient consent and their understanding of the potential risks of trauma surgery, no study has looked at the patient's understanding of the procedure involved with neck of femur fracture surgery. Method. Prospective analysis of 150 patients who had operative fixation of neck of femur fractures in a district general hospital. Patients were asked on the third post-operative day to select which procedure they had undergone from a diagram of four different neck of femur surgeries (cannulated screws, cephalomedullary nail, dynamic hip screw and hemiarthroplasty). Exclusion criteria for patient selection - mini mental score of < 20 and confusion secondary to delirium. Results. All patients had signed consent form 1 which was matched to the procedure. All patients were consented by an FP2, CT1 or other SHO. The mean age of patients was 83years. 5% had cannulated screw fixation, 45% had a hemiarthroplasty, 42% had a dynamic hip screw and 8% had a cephalomedullary nail. 47% of patients could correctly identify the procedure they had undergone on the 3. rd. post-operative day. Conclusions. This study shows that there are questions about the effectiveness of informed consent and patient understanding of the procedure before and after hip fracture surgery. We suggest that further detailed studies may highlight the need for alternative ways of communicating procedures to the patients or that more specialised training is required for those explaining hip fracture surgery to patients. Improvements in these areas might help ensure the true informed consent required

Purpose: To determine if femoral neck shortening after cannulated screw fixation has a negative impact on patients’ quality of life. Methods: Restrospective Observational Study. Database Review of 3 hospitals 1998–2003. Criteria: Inclusion: successfully treated hip# with cannulated screws. Exclusion:non union, malunion, implant failure, contralateral arthroplasty, death, dementia, illiterate, acute illness. Pts were evaluated with radiographic and outcome studies. Contralateral hip was the control for assessing radiographic parameters. Results: 56 eligible, 13 met criteria (12 non displaced, 1 displaced). Average(avg)follow up:31 months. 8 pts had femoral neck shortening greater than 5mm, avg abductor moment shortening of 8+/− 2.7mm, avg femoral neck shortening of 6+/−1.9mm in shortened pts. Significant differences (sf-36 subscales)between shortened and non shortened pts. Role physical 53 vs 95 (p=0.04) and physical function 50 vs 91 (p=0.01). Conclusions: Femoral neck shortening after fixation is associated with a negative effect impact on quality of life

This purpose of this study was to investigate whether prophylactic pinning of the contralateral hip in unilateral slipped upper femoral epiphysis affects subsequent femoral morphology. To determine the effect of prophylactic pinning on growth we compared contralateral hip radiographs of 24 proximal femora prophylactically pinned with 26 cases observed, in a cohort of patients with unilateral SUFE. Validated measurements were used to determine hip morphology; the articulo-trochanteric distance (ATD) and the ratio of the trochanteric-trochanteric distance (TTD) to articulo-trochanteric distance (TTD:ATD) in addition to direct measurement of the femoral neck length. Post-operative radiographs were compared to radiographs taken at a 12–84 months follow-up. Comparing pinned and unpinned hips the neck length was shorter (mean 5.1 mm vs 11.1 mm) and the ATD was lower (p=0.048). The difference between initial and final radiograph TTD:ATD ratio for each case was calculated. The average was 0.63 in the prophylactically pinned group and 0.25 in the unpinned group (p=0.07). When hips of the same patient were compared on final radiographs, there was a smaller difference in TTD:ATD between the two sides when the patient had been prophylactically pinned (0.7) as opposed to observed (1.47). This was not statistically significant (p=0.14). Universal prophylactic pinning of the contralateral hip in slipped upper femoral epiphysis is controversial and alteration of the proximal femoral morphology is one reason for this. Our results show that prophylactic pinning does not stop growth but does alter subsequent proximal femoral morphology by causing a degree of coxa vara and breva. Some loss of growth in the prophylactically pinned hip contributes to reduction in leg length inequality at skeletal maturity which is advantageous. No iatrogenic complications were observed with single cannulated screw fixation. Prophylactic pinning prevents the potential catastrophe of a subsequent slip, is safe and the effect on growth is, if anything, beneficial. Level of evidence: III

Proximal femoral fractures remain the most common reason for admission to hospital following orthopaedic injury, with an annual cost of £1.7 billion to the National Health Service and social care services. Fragility fractures of the hip in the elderly are a substantial cause of mortality and morbidity. Revision surgery for any cause carries a higher morbidity, mortality, healthcare- and social economic burden. Which patients suffer failed surgery and the reasons for failure have not been established. The aim of this study was to determine which patients are at risk of failed proximal femoral fracture surgery, the mechanism and cause fo failed surgery and modifiable patient factors associated with failure of hip fracture surgery. From prospectively collected data of 795 consecutive proximal femoral fractures admitted between July 2007 and July 2008, all peri-operative and post-operative complications were identified. 55 (6.9%) patients were found to have developed a surgical complication requiring further intervention. Risk factors included younger age (p=0.01), smoking (p=0.01) and cannulated screw fixation (p<0.01). Cannulated screw fixation was associated with a 30.9% complication rate. Mechanical cause was the most common reason for cannulated screw failure. Hip hemiarthroplasty most commonly failed by infective causes. Inter-trochanteric and subtrochanteric fracture fixation had very low failure rates. Surgical complication was not found to be associated with an increased mortality but a post-operative medical complication (21.8%) was associated with higher rate of mortality at 4-years (78.5%) and shorter time to mortality. (Median time 0.16 years (95% CI 0.00–0.33)

INTRODUCTION – Tuberosity fractures of the calcaneum are rare injuries. The traditional operative treatment involves open reduction and internal fixation with a tension band wire construct. We have developed a new technique of fixing these fractures with internal fixation using cannulated screws and a figure of eight wire. This paper describes the new technique outlining its advantages and compares the 2 methods of fixation biomechanically to determine their properties with respect to fracture fixation. METHOD – 20 sections of bovine bone were taken to act as an experimental model for the calcaneum. They were osteotomised to create the posterior process fracture model. 10 were fixed using a traditional tension band wire construct and 10 were fixed using the cannulated screw and wire construct. Each construct was subjected to biomechanical testing to identify the stiffness, energy to failure and load to failure. RESULTS – During loading the cannulated screw and wire constructs showed a significant increase in stiffness and energy to failure compared to the tension band wire constructs. CONCLUSION – The increased stability of the cannulated screw construct demonstrated by the testing offers biomechanical benefit over the traditional tension band wire construct. This, as well as the improved technical aspects of the cannulated screw fixation, may be beneficial for clinical use

The consequences of the complications associated with the management of slipped upper femoral epiphysis are a major source of disability in young adults. Whilst the management of chondrolysis, avascular necrosis or malunion of the femoral neck is usually undertaken by paediatric orthopaedic surgeons the initial management of SUFE in many regions is as part of an adult trauma service. This retrospective audit assessed the outcome of the management of SUFE in one such health region in which treatment occurred at three sites by a number of surgeons of varying experience, during the period July 1994 to June 2004. The aim was to compare our outcomes with those published and to identify whether our service should be altered as a consequence. The case notes and x-rays as recorded in theatre records were retrieved. Of the 64 cases that were treated during this period adequate records for 60 patients were available. Of these 60 patients there were 7 bilateral cases. Fixation in all 67 cases was by a single cannulated screw. In the 53 unilateral cases 17 underwent prophylactic pinning, the remaining 36 remained under observation. Of these nine patients presented with subsequent slips, eight of which were unstable and two had slip angles greater than 60° in which one developed avascular necrosis. Four other cases of avascular necrosis were observed (incidence 6%). Chondrolysis occurred in one patient with persistent pin penetration. In the remaining 73 cannulated screws used for stabilisation and 17 for prophylactic fixation no complications were observed. The complication rates observed in this series are within those accepted in the literature. The high incidence of subsequent slips and the attendant severity of these when compared with the relative safety of contemporary cannulated screw fixation has led us to recommend prophylactic pinning in our region

Background: Fracture of the scaphoid bone is the most common fracture of the carpus and frequently diagnosis is delayed. The unique anatomy & blood supply of the scaphoid itself predisposes to delayed union or non-union. The Synthes scaphoid screw is a cannulated headed screw, which provides superior compression compared with some other devices used to internally fix scaphoid non-unions. Aim: To conduct a retrospective study looking at union rate, time to union and complications and correlating the outcome of treatment against the delay between injury and surgery and location of the fracture within the bone. Methods: 36 patients with scaphoid non-union (30 waist & 6 proximal pole) treated by a single surgeon with the cannulated Synthes screw & corticocancellous bone graft were reviewed retrospectively. Results: We achieved 78% overall union rate. Those patients operated within 6 months of injury achieved 100% union rate. Of the patients with persistent non-union after surgery, half reported no pain and increased movement in the wrist. The failure rate was high in patients whose injury was more than 5 years old, and in proximal pole non-unions. Conclusion: Our study demonstrates that cannulated screw fixation with bone grafting has high success rate for delayed union of scaphoid waist fractures and scaphoid waist nonunions present for less than 5 years. Patients who present more than 5 years after injury or with proximal pole nonunions have a high chance of persistent nonunion, but can symptomatically improve

Background: To highlight the higher incidence of sub-trochanteric fracture following cannulated screws fixation for the neck of femur fracture, which may be due to surgical errors and osteoporotic bone. Method: Illustrative case report of a 78 years old demented independently mobile female patient who was admitted with an intracapsular Neck of Femur fracture, treated with cannulated screws. 2 weeks post operatively, she developed subtrochanteric undisplaced proximal femoral fracture without any trauma. She was treated with cemented hemiarthroplasty. Conclusion: The valgus impacted neck of femur fracture, treated with cannulated screws is associated with some inherent problems. The cannulated screws can become incarcerated during initial open-reduction internal fixation and break. The incidence of subtrochanteric fracture following hip operation is greater with an entry point in the lateral cortex below the level of the most inferior edge of the lesser trochanter. Although in our case study, we placed the screw above the lesser trochanter. It has been reported that two screws in the inferior part of the femoral neck create a stress riser in the sub-trochanteric region, potentially inducing a fracture in the weakened bone, and it may be induced by a trauma. In this case study failure may be due to multiple drill holes on the lateral cortex during insertion of the guide wire [fig 2]. Subtrochanteric fracture following cannulated screws may occur without trauma. Osteoporosis may have a major role to play. We recommend one screw infe-riorioly and entry point above the lesser trochanter as reported previously

Purpose: Open reduction and internal fixation (ORIF) is considered the treatment of choice in dislocated acetabular fractures. However ORIF has several drawbacks, such as intra operative blood loss, operative trauma and septic complications. To overcome these problems we applied percutaneous cannulated screw fixation in some cases. Methods: 198 acetabular fractures were treated between 1996 and 2003 in our department. According to the AO classification there were: 74 type A, 99 type B and 25 type C cases. The causes of the trauma were fall from high at 29, traffic accident at 112 and simple drop with osteoporosis in 57 patients. There were 29 polytraumatized and 46 multitraumatized patients. The 89 non-displaced fractures were treated conservatively: 8–12 weeks non-weight bearing were applied. The other cases were treated surgically: the simple wall fractures with screws, the column fractures with plates. The ilioinguinal approach was used in 11 and the Kocher-Langenbeck in 92 patients. Recently we have started to apply a percutaneous technique with cannulated screws. We used them at the fractures of the roof of the acetabulum and at elderly patients who had moderately dislocated anterior column fracture. We applied this technique in 6 cases. Results: In the cannulated screw group there was no intra- or postoperative complication, and the functional results have been excellent or good. In those cases, where the fracture involved the posterior wall or the posterior column, and percutaneous reduction could not have been achieved; we made open reduction, and ORIF. Conclusions: Percutaneous cannulated screw technique can be useful in the treatment of the fractures of the anterior column and the dome of the acetabulum

Aims and Methods: Hungary, 60% (3500 cases annually) of all fresh intracapsular femoral neck fractures are traditionally treated by osteosynthesis. Since 1990 nailing has been replaced: from 01.11.1990 to 31.08.2002 the authors performed 3092 procedures using percutaneous double cannulated screw fixation combined with a special tension band plate. The authors based the development of their In technique on results from research done by Woodhouse and Rösing. They proved by animal experiment that total femoral head ischaemia will already lead to irreversible necroses after just 6 hours. Results: The rate of late femoral head collapse at 3–6 years follow-up assessment is significantly lower if osteosynthesis is performed within 6 hours after the accident, i.e. in the phase of reversible ischaemia (p< 0,001). Followup assessment after 3–4 years was possible within the frame of international collaborations (SAHFE) with the same initial results for two groups treated by cannulated screw in 1993–94 and 1997–98 respectively. Emergency treatment also has a favourable somatomental effect on elderly patients. Conclusions: In a work-up of the 3 year follow-up results of 486 femoral neck fracture patients operated over a 2 year period, it was found that reposition and osteosynthesis done within 6 hours significantly decreased the ratio of the development of late femoral head necrosis and non-union. In addition to surgery performed within a short period of time, we consider that the exact anatomical repositioning and the correct placing of the osteosynthesis materials, that is, a good surgical technique is very important

Introduction: The consequences of the complications associated with the management of slipped upper femoral epiphysis are a major source of disability in young adults. Whilst the management of chondrolysis, avascular necrosis or malunion of the femoral neck is usually undertaken by paediatric orthopaedic surgeons the initial management of SUFE in many regions is as part of an adult trauma service. This retrospective audit assessed the outcome of the management of SUFE in one such health region in which treatment occurred at three sites by a number of surgeons of varying experience. The aim was to compare our outcomes with those published and to identify any local issues. Method: Review of case notes and xrays of all patients treated over a ten year period as recorded in theatre records. Fixation in all cases was by a single cannulated screw. Results: Of the 64 cases that presented during this period adequate records for 60 patients were retrieved. 75 slips were recorded, 15 of which were bilateral. In 17 patients prophylactic pinning was performed in the remaining 43 patients nine presented with subsequent slips. Of these, eight were unstable of which two had slip angles greater than 60°, in one of these avascular necrosis developed. Three other cases of avascular necrosis occurred (incidence 5%) all in unstable slips. Chondrolysis occurred in one patient with persistent pin penetration. In the remaining 91 cannulated screws that were inserted no complications were observed. Discussion: The complication rates observed in this series are within those accepted in the literature. The high incidence of subsequent slips and the attendant severity of these when compared with the relative safety of contemporary cannulated screw fixation has lead us to recommend prophylactic pinning in our region

Objective: The purpose of this communication was to evaluate the long-term outcome of patients with type II odontoid fractures treated with anterior screw fixation. Material and Methods: In our prospective clinical study 34 patients, 21 males and 13 females (with mean age 35.4 + 0.8 years) with type II odontoid fractures of traumatic etiology, underwent anterior cannulated screw fixation, during a period of 36 months. All patients had radiologicaly confirmed intact transverse ligament and a reducible odontoid fracture. All patients were immobilized in a Miami J cervical collar for 4 weeks postoperatively. Radiological examination of the cervical spine with plain X rays and cervical spine CT was performed at 6 weeks and two, six and 12 and 24 months postoperatively. Follow-up time ranged between 36 and 80 months (mean follow-up 54.3+ months). Results: 32 patients had an uneventful postoperative course, while one patient developed pulmonary atelectasis, which resolved without any significant sequelae and another one developed a superficial wound infection, which resolved without removing the implanted hardware. Radiographic evaluation showed satisfactory bony fusion and no evidence of abnormal movement at the fracture site in 31 patients (91.1%). In two patients (5.8%), the radiographic studies showed pseudo-arthrosis and instability while in one patient (2.9%) the implanted cannulated screw was broken but there was no instability shown. Conclusions: In our series anterior odontoid screw fixation constituted a safe therapeutic modality with high stability and low mechanical failure rates in short and long term follow-up period