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Spine. 2022 Jul 14. doi: 10.1097/BRS.0000000000004369. pii: 00007632-990000000-00048

Biomechanical Determination of Fracture Loads and Patterns of the Odontoid Process.

Benca E¹, Zderic I², van Knegsel KP³, Caspar J⁴, Hirtler L⁵, Fuchssteiner C⁶, Strassl A⁷, Gueorguiev B⁸, Widhalm H⁹, Windhager R¹⁰, Varga P¹¹

Author information

¹Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria, Währinger Gürtel 18-20, 1090 Vienna, Austria.
²AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland.
³AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland.
⁴AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland.
⁵Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Währinger Strasse 13, 1090 Vienna, Austria.
⁶Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Währinger Strasse 13, 1090 Vienna, Austria.
⁷Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria, Währinger Gürtel 18-20, 1090 Vienna, Austria.
⁸AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland.
⁹Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria, Währinger Gürtel 18-20, 1090 Vienna, Austria.
¹⁰Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria, Währinger Gürtel 18-20, 1090 Vienna, Austria.
¹¹AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland.

Abstract

STUDY DESIGN: Laboratory study.

OBJECTIVE: This study aimed to investigate the biomechanical competence and fracture characteristics of the odontoid process.

SUMMARY OF BACKGROUND DATA: Odontoid fractures of the second cervical vertebra (C2) is the most common fracture type in cervical- and spine in general in the elderly. However, very little is known about the underlying biomechanical fracture mechanisms.

METHODS: A total of 42 human C2 specimens were Scanned using a QCT, divided in 6 groups, and subjected to combined quasi-static loading at -15°, 0°, and 15° in sagittal plane and -50° and 0° in transverse plane until fracture. Bone mineral density (BMD), height, state of the fusion of the ossification centers, stiffness, yield load, and ultimate load were assessed.

RESULTS: While the lowest values for stiffness, yield, and ultimate load were observed at load inclination of 15° in the sagittal plane, no statistically significant differences could be observed between the six groups (P=0.235, P=0.646, and P=0.505, respectively). BMD was positively correlate with the yield (r²=0.350, P<0.001), and ultimate load (r²=0.955, P<0.001), but not with the stiffness (r²=0.082, P=0.07). The analysis of the mechanical quantitates for specimens with clearly distinguishable fusion of the ossification centers (26 specimens) reveled less differences between the mean values.

CONCLUSION: Load direction plays a subordinate role in traumatic fractures of the odontoid process. BMD was associated with significant correlation to the biomechanical outcomes. Thus, odontoid fractures appear to be the results of an interaction between the load magnitude and bone quality.

Publikations ID: 35853162
Quelle: öffnen

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