Christopher K Kepler1, Alexander R Vaccaro1, Andrew N Fleischman1, Vincent C Traynelis2, Alpesh A Patel3, Mark B Dekutoski4, James Harrop1, Kirkham B Wood5, Gregory D Schroeder1, Richard Bransford6, Bizhan Aarabi7, David O Okonkwo8, Paul M Arnold9, Michael G Fehlings10, Ahmad Nassr11, Christopher Shaffrey12, S Tim Yoon13, Brian Kwon14. 1. Rothman Institute & Thomas Jefferson University Hospital. 2. Rush University Medical Center. 3. Northwestern Memorial Hospital, Chicago, IL. 4. The CORE Institute, Phoenix, AZ. 5. Massachusetts General Hospital, Boston, MA. 6. Department of Orthopaedic Surgery, University of Washington, Seattle, WA. 7. Department of Neurosurgery, University of Maryland, Baltimore, MD. 8. Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA. 9. Department of Neurosurgery, University of Kansas, Kansas City, KS. 10. Department of Neurosurgery, University of Toronto, Toronto, ON, Canada. 11. Mayo Clinic, Rochester, MN. 12. Department of Neurosurgery, University of Virginia, Charlottesville, VA. 13. Department of Orthopaedic Surgery, Emory University, Atlanta, GA. 14. Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC, Canada.
Abstract
STUDY DESIGN: Evidence-based systematic review. OBJECTIVES: To define the optimal treatment of fractures involving the C2 body, including those with concomitant injuries, based upon a systematic review of the literature. SUMMARY OF BACKGROUND DATA: Axis body fractures have customarily been treated nonoperatively, but there are some injuries that may require operative intervention. High-quality literature is sparse and there are few class I or class II studies to guide treatment decisions. MATERIALS AND METHODS: A literature search was conducted using PubMed (MEDLINE), Cochrane Central Register of Controlled Trials, and Scopus (EMBASE, MEDLINE, COMPENDEX). The quality of literature was rated according to a grading tool developed by the Center for Evidence-based Medicine. Operative and nonoperative treatment of axis body fractures were compared using fracture bony union as the primary outcome measure. As risk factors for nonunion were not consistently reported, cases were analyzed individually. RESULTS: The literature search identified 62 studies, of which 10 were case reports which were excluded from the analysis. A total of 920 patients from 52 studies were included. The overall bony union rate for all axis body fractures was 91%. Although the majority of fractures were treated nonoperatively, there has been an increasing trend toward operative intervention for Benzel type III (transverse) axis body fractures. Nearly 76% of axis body fractures were classified as type III fractures, of which 88% united successfully. Nearly all Benzel type I and type II axis body fractures were successfully treated nonoperatively. The risk factors for nonunion included: a higher degree of subluxation, fracture displacement, comminution, concurrent injuries, delay in treatment, and older age. CONCLUSIONS: High rates for fracture union are reported in the literature for axis body fractures with nonoperative treatment. High-quality prospective studies are required to develop consensus as to which C2 body fractures require operative fixation.
STUDY DESIGN: Evidence-based systematic review. OBJECTIVES: To define the optimal treatment of fractures involving the C2 body, including those with concomitant injuries, based upon a systematic review of the literature. SUMMARY OF BACKGROUND DATA: Axis body fractures have customarily been treated nonoperatively, but there are some injuries that may require operative intervention. High-quality literature is sparse and there are few class I or class II studies to guide treatment decisions. MATERIALS AND METHODS: A literature search was conducted using PubMed (MEDLINE), Cochrane Central Register of Controlled Trials, and Scopus (EMBASE, MEDLINE, COMPENDEX). The quality of literature was rated according to a grading tool developed by the Center for Evidence-based Medicine. Operative and nonoperative treatment of axis body fractures were compared using fracture bony union as the primary outcome measure. As risk factors for nonunion were not consistently reported, cases were analyzed individually. RESULTS: The literature search identified 62 studies, of which 10 were case reports which were excluded from the analysis. A total of 920 patients from 52 studies were included. The overall bony union rate for all axis body fractures was 91%. Although the majority of fractures were treated nonoperatively, there has been an increasing trend toward operative intervention for Benzel type III (transverse) axis body fractures. Nearly 76% of axis body fractures were classified as type III fractures, of which 88% united successfully. Nearly all Benzel type I and type II axis body fractures were successfully treated nonoperatively. The risk factors for nonunion included: a higher degree of subluxation, fracture displacement, comminution, concurrent injuries, delay in treatment, and older age. CONCLUSIONS: High rates for fracture union are reported in the literature for axis body fractures with nonoperative treatment. High-quality prospective studies are required to develop consensus as to which C2 body fractures require operative fixation.