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Management of Combined Atlas Fracture with Type II Odontoid Fracture: A Review of 21 Cases

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Abstract

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 Cj-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 C1 fracture and atlantoaxial stability. The treatment principle can obtain satisfactory results for the management of C1-type II odontoid fractures.

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Authors and Affiliations

  1. Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, 1 Qiuyang Road, Fuzhou 350122, Fujian, China

    Zhong-Sheng Zhao, Guang-Wen Wu, Jie Lin, Ying-Sheng Zhang, Yan-Feng Huang &  Chun-Song Zheng

  2. Department of Orthopedics, the 175th Hospital of PLA, The Affiliated Southeast Hospital of Xiamen University, 269 Zhanghua Road, Zhangzhou 363000, Fujian, China

    Zhi-Da Chen &  Bin Lin

Authors
  1. Zhong-Sheng Zhao
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  2. Guang-Wen Wu
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  3. Jie Lin
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  4. Ying-Sheng Zhang
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  5. Yan-Feng Huang
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  6. Zhi-Da Chen
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  7. Bin Lin
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  8. Chun-Song Zheng
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Correspondence to Bin Lin or Chun-Song Zheng.

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Zhao, ZS., Wu, GW., Lin, J. et al. Management of Combined Atlas Fracture with Type II Odontoid Fracture: A Review of 21 Cases. JOIO 53, 518–524 (2019). https://doi.org/10.4103/ortho.IJOrtho_249_18

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  • DOI: https://doi.org/10.4103/ortho.IJOrtho_249_18

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