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Abstract: The dentate process refers to the bony projection in front of the second cervical vertebra (cardinal vertebra). A fracture of the dentate process is so high that if the fracture affects the posterior spinal cord and brainstem, it can lead to acute high-grade neurological injury, causing respiratory and circulatory impairment, tetraplegia, and even death. In this case, the patient was a delivery boy who suffered a fracture of the dentate process in a traffic accident while delivering food, and the fracture was significantly displaced.
Basic information】Male, 28 years old
Disease Type】Dentate fracture
Hospital】The First Hospital of Harbin Medical University
Date of consultation】January 2022
Treatment plan】Surgical treatment (cervical posterior repositioning internal fixation surgery)
Treatment Period】10 days of inpatient treatment and regular outpatient follow up
Effectiveness】Fracture healing and normalization of function
I. Initial consultation
The patient was a delivery boy who was rear-ended by a car on his way to deliver food. Fortunately, he was wearing a safety helmet at that time, but he was still conscious after the injury, but his neck was too painful to move. The cervical spine fracture was highly suspected. The patient was finally diagnosed with a fracture of the dentate process, and was admitted to the hospital in an emergency to prepare for surgery.
(X-ray taken in emergency)
II. Treatment process
Immediately after admission, the patient was instructed to stay in bed absolutely and not to turn over at will, and was given cervical occipito-mandibular sling traction to prevent re-displacement of the dentate fracture, which could aggravate spinal cord injury. On the second day after admission, posterior cervical spine internal fixation surgery was performed on an emergency basis, and the incision was changed once every 2 days after surgery. The drainage tube was removed 3 days after surgery, and the patient was discharged on the 8th postoperative day. The stitches were removed 2 weeks after surgery, and the patient was protected with a head, neck and chest brace for 3 months.
III. Treatment effect
The postoperative X-ray was reviewed, and the position of the dentate was normalized. Three days after surgery, the patient felt that the weakness of the limbs was better than before surgery, and there was no numbness in the skin, and he started to leave the bed wearing a head, neck and chest brace. On the 8th postoperative day, that is, the 10th day of hospitalization, the patient could walk with the help of the railing, and was discharged at this time. Two weeks after surgery, the incision healed, and the stitches were removed in the hospital for review, at which time the fracture recovered well. Three months after the surgery, the brace was removed and the neck flexion and extension were basically normal, with a slight stiffness when the head was rotated and normal walking. In conclusion, through timely treatment, the anatomical form of the dentate process and the stability of the cervical spine were restored, and the sensory and motor functions of the extremities were normalized. The patient was very satisfied with the treatment effect.
IV. Notes
We are glad that the fracture healed and the limbs returned to normal function after treatment. Since internal cervical spine fixation helps maintain atlantoaxial stability, this patient did not require absolute bed rest and cervical braking after surgery. However, the head, neck, and chest brace should be worn after waking up and after discharge until the fracture heals, which is about 3 months. After discharge, head and neck twisting movements should be avoided and normal activities should be allowed once the fracture has healed, but neck trauma should be avoided. The internal fixation needs to be removed after the fracture heals, usually 1 year after the surgery, otherwise it will break easily.
V. Personal insight
Although this patient’s dentate fracture was obviously displaced, the cervical spinal canal was still open and the spinal cord and nerves were not significantly compressed. However, if the fracture is not taken seriously or treated improperly, it may lead to an increase in the degree of fracture displacement and even atlantoaxial dislocation, causing acute spinal cord compression, which may be life-threatening.