• Carolin Meyer, Johannes Oppermann, Ingo Meermeyer, Peer Eysel, Lars Peter Müller, and Gregor Stein.
• Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland. carolin.meyer@uk-koeln.de.
• Unfallchirurg. 2018 May 1; 121 (5): 397-402.

BackgroundThe most effective treatment of type II dens fractures according to Anderson and D'Alonzo remains controversial as there is no guidance on the choice of conservative or surgical therapy and if the anterior or the posterior approach is more advantageous. In 1993 Eysel and Roosen showed that the consolidation rate of type II odontoid fractures mostly depends on the morphology of the fracture and established a classification with corresponding treatment recommendations.ObjectiveThe investigation aimed at clarifying the outcome of type II dens fractures treated according to the recommendations of Eysel and Roosen.Material And MethodsData of dens fractures from 72 patients were analyzed and categorized according to the Eysel and Roosen classification. Furthermore, the treatment was analyzed and the outcome was evaluated retrospectively using radiographs acquired during follow-up.ResultsThe mean age of the 72 patients was 70.7 years. Of the patients 19.4% suffered from type A, 75% from type B and 5.6% from type C fractures according to Eysel and Roosen. Out of the 72 patients 45 were assessed by computed tomography (CT) scan during follow-up. According to the recommendations of the authors 34 of the 41 patients with type A or type B fractures underwent anterior screw fixation of the dens and 3 out of the 4 patients with a type C fracture underwent a dorsal C1 and C2 fusion. After a mean follow-up of 7 months non-union was observed in 15.6% of the patients whereby 6 of the these patients were treated by surgery and 1 patient was managed conservatively. All of the patients who developed a non-union had a type B fracture.ConclusionThe simple clinical applicability together with the low rate of non-union development shows that the Eysel and Roosen classification appears to be a suitable guide for clinical use when deciding on the appropriate treatment regimen.

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