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Zhiyuan Yu, Rui Guo, Jun Zheng, Hao Li, Chao You, and Lu Ma

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Xue-song Liu, Chao You, Ma Lu, and Jia-gang Liu


A growing skull fracture (GSF) is a rare but significant late complication of skull fractures, usually occurring during infancy and early childhood. Delayed diagnosis and improper treatment could exacerbate this disease. The aim of this study was to introduce a new hypothesis about, describe the stages of, and discuss the treatment strategy for GSF.


The authors performed a retrospective review of 27 patients with GSF, who were grouped according to 3 different GSF stages.


Over a period of 20 years, 27 patients with GSF (16 males and 11 females) were treated in the authors' department. The mean follow-up period was 26.5 months. Six patients were in the prephase of GSF (Stage 1), 10 patients in the early phase (Stage 2), and 11 in the late phase (Stage 3). All patients underwent duraplasty. All 6 patients at Stage 1 and 5 patients at Stage 2 underwent craniotomy without cranioplasty. Five patients at Stage 2 and all of the patients at Stage 3 underwent cranioplasty with autologous bone and alloplastic materials, respectively. Among all patients, 5 underwent ventriculoperitoneal shunt placement.

Symptoms in all patients at Stages 1 and 2 were alleviated or disappeared, and the cranial bones developed without deformity during follow-up. Among patients with Stage 3 GSF, no obvious improvement in neurological deficits was observed. Three patients underwent additional operations because of cranial deformation or infection.


The authors identify the stages of GSF according to a new hypothesis. They conclude that accurately diagnosing and treating GSF during Stages 1 and 2 leads to a better prognosis.

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Zhiyuan Yu, Jun Zheng, Rui Guo, Chao You, Hao Li, and Lu Ma

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Zhiyuan Yu, Jun Zheng, Lu Ma, Chao You, and Hao Li

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Yue-Qi Du, Teng Li, Chao Ma, Guang-Yu Qiao, Yi-Heng Yin, and Xin-Guang Yu


The authors conducted a study to investigate the biomechanical feasibility and stability of C1 lateral mass–C2 bicortical translaminar screw (C1LM-C2TL) fixation, C1 lateral mass–C2/3 transarticular screw (C1LM-C2/3TA) fixation, and C1LM-C2/3TA fixation with transverse cross-links (C1LM-C2/3TACL) as alternative techniques to the Goel-Harms technique (C1 lateral mass–C2 pedicle screw [C1LM-C2PS] fixation) for atlantoaxial fixation.


Eight human cadaveric cervical spines (occiput–C7) were tested using an industrial robot. Pure moments that were a maximum of 1.5 Nm were applied in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). The specimens were first tested in the intact state and followed by destabilization (a type II odontoid fracture) and fixation as follows: C1LM-C2PS, C1LM-C2TL, C1LM-C2/3TA, and C1LM-C2/3TACL. For each condition, the authors evaluated the range of motion and neutral zone across C1 and C2 in all directions.


Compared with the intact spine, each instrumented spine significantly increased in stability at the C1–2 segment. C1LM-C2TL fixation demonstrated similar stability in FE and LB and greater stability in AR than C1LM-C2PS fixation. C1LM-C2/3TA fixation was equivalent in LB and superior in FE to those of C1LM-C2PS and C1LM-C2TL fixation. During AR, the C1LM-C2/3TA–instrumented spine failed to maintain segmental stability. After adding a cross-link, the rotational stability was significantly increased in the C1LM-C2/3TACL–instrumented spine compared with the C1LM-C2/3TA–instrumented spine. Although inferior to C1LM-C2TL fixation, the C1LM-C2/3TACL–instrumented spine showed equivalent rotational stability to the C1LM-C2PS–instrumented spine.


On the basis of our biomechanical study, C1LM-C2TL and C1LM-C2/3TACL fixation resulted in satisfactory atlantoaxial stabilization compared with C1LM-C2PS. Therefore, the authors believe that the C1LM-C2TL and C1LM-C2/3TACL fixation may serve as alternative procedures when the Goel-Harms technique (C1LM-C2PS) is not feasible due to anatomical constraints.

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Oliver Daniel Mowforth, Michelle Louise Starkey, Mark Reinhard Kotter, and Benjamin Marshall Davies

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Yu-Chi Tsai, Fang-Chen Liu, Chao-Ming Chang, Che-Hsien Chang, Yin-Hsien Liao, Tse-Bing Yang, and Dueng-Yuan Hueng