Management of combined atlas fracture with type II odontoid fracture: A review of 21 cases
Zhong-Sheng Zhao1, Guang-Wen Wu1, Jie Lin1, Ying-Sheng Zhang1, Yan-Feng Huang1, Zhi-Da Chen2, Bin Lin2, Chun-Song Zheng1
1 Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
2 Department of Orthopedics, The 175th Hospital of PLA, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, Fujian, China
Department of Orthopedics, the 175th Hospital of PLA, The Affiliated Southeast Hospital of Xiamen University, 269 Zhanghua Road, Zhangzhou 363000, Fujian
Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, 1 Qiuyang Road, Fuzhou 350122, Fujian
Source of Support: None, Conflict of Interest: None
Purpose: To evaluate the therapeutic effects of combined atlas fracture with type II (C1-type II) odontoid fractures and to outline a management strategy for it. Patients and Methods: Twenty three patients with C1-type II odontoid fractures were treated according to our management strategy. Nonoperative external immobilization in the form of cervical collar and halo vest was used in 13 patients with stable atlantoaxial joint. Surgical treatment was early performed in 10 patients whose fractures with traumatic transverse atlantal ligament disruption or atlantoaxial instability. The visual analog scale (VAS), neck disability index (NDI) scale, and American Spinal Injury Association (ASIA) scale at each stage of followup were then collected and compared. Results: Compared to pretreatment, the VAS score, NDI score, and ASIA scale were improved among both groups at followup evaluation after treatment. However, in the nonsurgical group, one patient (1/11) developed nonunion which required surgical treatment in later stage and one patient (1/13) with halo vest immobilization had happened pin site infection. Two patients of the surgical group (2/11) had appeared minor complications: occipital cervical pain in one case and cerebrospinal fluid leakage in one case. Two patients (2/23) were excluded from nonsurgical treatment group because their followup period was less than 12 months. Twenty one patients were followed up regularly with an average of 23.9 months (range 15–45 months). Conclusions: We outlined our concluding management principle for the treatment of C1-type II odontoid fractures based on the nature of C1fracture and atlantoaxial stability. The treatment principle can obtain satisfactory results for the management of C1-type II odontoid fractures.