Management of acute combined fractures of the atlas and axis: A retrospective study of two trauma centers

Joseph DiDomenico; Kingsley Abode-Iyamah; Ryan Khanna; Helena Roberts; Patrick A Hitchon; Zachary A Smith; Nader S Dahdaleh

doi:10.4103/jcvjs.JCVJS_53_17

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$Management of acute combined fractures of the atlas and axis: A retrospective study of two trauma centers$

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Management of acute combined fractures of the atlas and axis: A retrospective study of two trauma centers

Joseph DiDomenico, Kingsley Abode-Iyamah, Ryan Khanna, Helena Roberts, Patrick A Hitchon, Zachary A Smith and Nader S Dahdaleh

Journal of craniovertebral junction and spine, Vol.8(4), pp.311-315

10/2017

DOI: 10.4103/jcvjs.JCVJS_53_17

PMCID: PMC5763586

PMID: 29403241

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Abstract

Management of combination fractures of the atlas and axis varies from nonoperative immobilization to selective early surgical intervention. In this study, we present our experience in managing these injuries. Electronic databases from two level 1 trauma centers were queried to identify all patients diagnosed with C1-C2 combination fractures from 2009 to present. Patient demographics, fracture characteristics, treatment modality, complications, Frankel scores, and fusion status were collected. Patients were separated into operative and nonoperative cohorts, and comparisons were made between the two groups. Forty-eight patients were included, of which 19 received operative management and 29 were treated nonoperatively. The mean age was 76.1 and 75.3 years, respectively ( = 0.877). Frankel grade distribution was similar on presentation in both groups, with most being neurologically intact. C1 fractures of both the anterior and posterior arch were present in 41.2% patients undergoing fusions compared to 27.6% of patients treated nonoperatively. No significant differences in comorbidities, neurologic deficits, or radiographic measurements were observed across the two groups. This study demonstrates the variety of treatment strategies used for the management of combined C1-C2 fractures. Patients managed operatively tend to have both anterior and posterior C1 arch fractures, while patients managed nonoperatively tend to have either anterior or posterior arch fractures. In general, treatments should be tailored to patients' needs depending on the stability of the fractures, neurological state, and medical comorbidities.

atlas

cervical fracture

combination fractures

axis

Atlantoaxial

Details

Title: Subtitle: Management of acute combined fractures of the atlas and axis: A retrospective study of two trauma centers
Creators: Joseph DiDomenico - Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611-2911, USA
Kingsley Abode-Iyamah - Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
Ryan Khanna - Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611-2911, USA
Helena Roberts - Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611-2911, USA
Patrick A Hitchon - Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
Zachary A Smith - Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611-2911, USA
Nader S Dahdaleh - Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611-2911, USA
Resource Type: Journal article
Publication Details: Journal of craniovertebral junction and spine, Vol.8(4), pp.311-315
DOI: 10.4103/jcvjs.JCVJS_53_17
PMID: 29403241
PMCID: PMC5763586
NLM abbreviation: J Craniovertebr Junction Spine
ISSN: 0974-8237
eISSN: 0976-9285
Publisher: India
Language: English
Date published: 10/2017
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Neurosurgery
Record Identifier: 9984040261302771

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