Neurosurgical management of acute atlas-axis combination fractures

A review of 25 cases

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✓ Combination atlas-axis fractures occur relatively frequently and have a higher incidence of neurological morbidity than isolated C-1 or isolated C-2 injuries. Patients with combination C1–2 fracture-subluxation injuries should be studied with thin-section computerized tomography. Appropriate treatment is determined by the type of axis fracture present and includes surgical and nonsurgical strategies. An experience with 25 patients with combination C1–2 fractures is presented, and management and follow-up guidelines are reviewed.

Article Information

Address reprint requests to: Volker K. H. Sonntag, M.D., Editorial Office, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, Arizona 85013-4496.

© AANS, except where prohibited by US copyright law.

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Figures

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    Drawings showing four types of combination atlas-axis fractures: C-1-odontoid Type II fracture, seen in 10 cases (40%); C-1-miscellaneous C-2 fracture, seen in seven cases (28%); C-1-odontoid Type III fracture, seen in five cases (20%); and C-1-hangman's fracture seen in three cases (12%).

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    Lateral radiograph showing a hangman's C-2 fracture associated with a C-1 posterior arch fracture.

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    Open-mouth radiograph (left) and computerized tomography scan (right) showing undisplaced fractures of the lateral masses of C-1 and C-2 (arrow).

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    Initial treatment algorithm for combination atlas-axis fractures. Fx = fracture.

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