Complex atlantoaxial fractures.

OBJECT: The authors conducted a retrospective study to evaluate the treatment of complex C1-2 fractures.
METHODS: There were 10 cases of complex C1-2 fractures. Six patients were men (median age 58 years) and four patients were women (median age 55.5 years). Injuries resulted from seven falls, two motor vehicle accidents, and one diving incident. Three patients suffered from upper-extremity weakness. Neurological function in seven patients was intact preoperatively. Fracture combinations included six Jefferson/Type II odontoid, two anterior ring/Type II odontoid, one posterior ring/Type II odontoid, and one posterior ring/Type III odontoid/Type III hangman's fracture. All patients underwent surgery, five after halo immobilization for an average of 4 months failed to provide stability. Treatment included placement of six odontoid screws, one posterior C1-2 transarticular screw, one odontoid screw with anterior C1-2 transarticular screw fixation, one C1-2 transarticular screw with C1-2 Songer cable fusion, and one odontoid screw with bilateral C-2 pedicle screw fixation. Specific treatment was determined by the combination of fractures. Postoperatively, all patients were immobilized in a hard collar for 3 months. There were no intraoperative surgery-related complications. The mean follow-up period was 28.5 months. Neurological recovery was observed in one of three patients who presented with neurological deficits. Fusion occurred in all cases.
CONCLUSIONS: The goals in treating these complex fractures are to achieve early maximum stability and minimum reduction in range of motion. These are often competing phenomena. Frequently in cases of atlas-axis fracture, odontoid screw fixation combined with hard collar immobilization is the best therapy, provided the transverse atlantal ligament is competent. If not, C1-2 stabilization with placement of transarticular screws is required for best results.