Dong-Gune Chang1, Jong-Hyun Ko, Jong-Beom Park, Gang-Ik Ju. 1. From the Department of Orthopaedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea (Dr. Chang); the Department of Orthopaedic surgery, Chonbuk National University Hospital, Jeonju, Korea (Dr. Ko); and the Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea (Dr. Park and Dr. Ju).
Abstract
INTRODUCTION: To report the first case of traumatic C1-2 lateral subluxation with three-part fractures of the C2 axis (dens, lateral mass, and hangman fractures) that was successfully treated with only anterior dens screw fixation. METHODS: A 56-year-old man was admitted to the hospital complaining of neck and left arm pains caused by a pedestrian traffic accident. Radiologic examination revealed traumatic C1-2 lateral subluxation, type 3 dens fracture (Anderson and D'Alonzo classification), fracture of both C2 lateral masses, and type 1 hangman fracture (Levine and Edwards classification). RESULTS: Preoperative closed reduction of the C1-2 lateral subluxation was successfully achieved by skull traction using a Gardner-Wells tong. The patient underwent anterior dens screw fixation for type 3 dens fracture with posterior angulation. At the 2-year follow-up visit, good reduction of traumatic C1-2 lateral subluxation and solid fusion of all three-part fractures of the C2 axis were achieved with full range of motion and stability at the C1-2 joint. In addition, notable improvement of neck and left arm pains was achieved. DISCUSSION: Preoperative closed reduction and anterior dens screw fixation can be considered as a less invasive and motion-preserving surgery for traumatic C1-2 lateral subluxation with three-part fractures of the C2 axis.
INTRODUCTION: To report the first case of traumatic C1-2 lateral subluxation with three-part fractures of the C2 axis (dens, lateral mass, and hangman fractures) that was successfully treated with only anterior dens screw fixation. METHODS: A 56-year-old man was admitted to the hospital complaining of neck and left arm pains caused by a pedestrian traffic accident. Radiologic examination revealed traumatic C1-2 lateral subluxation, type 3 dens fracture (Anderson and D'Alonzo classification), fracture of both C2 lateral masses, and type 1 hangman fracture (Levine and Edwards classification). RESULTS: Preoperative closed reduction of the C1-2 lateral subluxation was successfully achieved by skull traction using a Gardner-Wells tong. The patient underwent anterior dens screw fixation for type 3 dens fracture with posterior angulation. At the 2-year follow-up visit, good reduction of traumatic C1-2 lateral subluxation and solid fusion of all three-part fractures of the C2 axis were achieved with full range of motion and stability at the C1-2 joint. In addition, notable improvement of neck and left arm pains was achieved. DISCUSSION: Preoperative closed reduction and anterior dens screw fixation can be considered as a less invasive and motion-preserving surgery for traumatic C1-2 lateral subluxation with three-part fractures of the C2 axis.
Authors: Christopher K Kepler; Alexander R Vaccaro; Andrew N Fleischman; Vincent C Traynelis; Alpesh A Patel; Mark B Dekutoski; James Harrop; Kirkham B Wood; Gregory D Schroeder; Richard Bransford; Bizhan Aarabi; David O Okonkwo; Paul M Arnold; Michael G Fehlings; Ahmad Nassr; Christopher Shaffrey; S Tim Yoon; Brian Kwon Journal: Clin Spine Surg Date: 2017-12 Impact factor: 1.876