Volume 13 - Supplement, Winter
aumj 2024, 13 - Supplement, Winter: 49-57 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Larijani A, Baradaran Bagheri A, Maleki H, Chavoshi-nejad M, Sarchahi S, Khalaji N. Rotational dislocation of the atlantoaxial joint associated with type 2 odontoid fracture in high energy trauma
A case report and review of articles. aumj 2024; 13 :49-57
URL: http://aums.abzums.ac.ir/article-1-1794-en.html
URL: http://aums.abzums.ac.ir/article-1-1794-en.html
Amirhossein Larijani1 
, Ali Baradaran Bagheri *1 , Hossein Maleki1 , Mehdi Chavoshi-nejad1 , Sina Sarchahi2 , Narges Khalaji3
, Ali Baradaran Bagheri *1 , Hossein Maleki1 , Mehdi Chavoshi-nejad1 , Sina Sarchahi2 , Narges Khalaji3
1- Assistant Professor of Neurosurgery, Clinical Research Development Unit of Shahid Madani Hospital , School of Medicine , Alborz University of Medical Sciences , Karaj, Iran
2- Neurosurgery residency student, Student Research Committee , School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
3- General medicine student , Student Research Committee , School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
2- Neurosurgery residency student, Student Research Committee , School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
3- General medicine student , Student Research Committee , School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
Abstract: (793 Views)
Background: The combination of atlantoaxial joint dislocation and fracture of the odontoid process is a rare but serious spine injury that causes instability. The estimated frequency of this combined injury is less than 2% among upper cervical spine dameges. Few clinical cases of mentioned damage has been reported in scientific resources. In this article, we present the prognosis of a patient with atlantoaxial joint dislocation along with odontoid fracture and discuss how to manage this type of combined injury.
Case presentation: A 19-year-old man presents with a fracture of the C2 axis in the odontoid process and posterior displacement of the atlas vertebra (C1) relative to C2 due to motor vehicle accident. posterior displacement was observed with bilateral dislocation of the lateral joints. Conservative treatment consisted axial traction with a halo head brace was performed to reduce the atlantoaxial dislocation. Because traction failed, we decided to perform surgery to reduce the dislocation and fix the C1-C2 joint.postoperative X-ray and CT scan were satisfactory. At the 6 months follow-up, the clinical picture was stable and the patient had no major functional problems. Dynamic X-ray Showed good range of motion in flexion and extension.
Conclusion: The combination of atlantoaxial joint dislocation and fracture of the odontoid process is a rare spine injury that is considered serious due to causing instability. First, we treat the dislocation, then the treatment of the fracture of the odontoid appendage is determined based on the results of displacement and its stability. Conservative treatment of dislocation includes axial traction with a halo head brace. If traction fails, an open reduction should be performed through the posterior approach with C1-C2 Magerl fixation. If this approach is not possible, occipitocervical fixation is performed. The rarely-used lateral approach has an advantage in this indication, because the atlantoaxial joint exposure is excellent and the option exists to perform anterior transarticular fusion.
Case presentation: A 19-year-old man presents with a fracture of the C2 axis in the odontoid process and posterior displacement of the atlas vertebra (C1) relative to C2 due to motor vehicle accident. posterior displacement was observed with bilateral dislocation of the lateral joints. Conservative treatment consisted axial traction with a halo head brace was performed to reduce the atlantoaxial dislocation. Because traction failed, we decided to perform surgery to reduce the dislocation and fix the C1-C2 joint.postoperative X-ray and CT scan were satisfactory. At the 6 months follow-up, the clinical picture was stable and the patient had no major functional problems. Dynamic X-ray Showed good range of motion in flexion and extension.
Conclusion: The combination of atlantoaxial joint dislocation and fracture of the odontoid process is a rare spine injury that is considered serious due to causing instability. First, we treat the dislocation, then the treatment of the fracture of the odontoid appendage is determined based on the results of displacement and its stability. Conservative treatment of dislocation includes axial traction with a halo head brace. If traction fails, an open reduction should be performed through the posterior approach with C1-C2 Magerl fixation. If this approach is not possible, occipitocervical fixation is performed. The rarely-used lateral approach has an advantage in this indication, because the atlantoaxial joint exposure is excellent and the option exists to perform anterior transarticular fusion.
Type of Study: Original |
Subject:
Special
Received: 2023/02/08 | Accepted: 2023/04/08 | Published: 2024/02/28
Received: 2023/02/08 | Accepted: 2023/04/08 | Published: 2024/02/28
References
1. Autricque A, Lesoin F, Villette L, Franz K, Pruvo JP, Jomin M. Fracture of the odontoid process and C1-C2 lateral luxation. Two cases. Ann Chir 1986;40:397-400.
2. Fuentes S, Bouillot P, Palombi O, Ducolombier A, Desgeorges M. Traumatic atlantoaxial rotatory dislocation with odontoid fracture: case report and review. Spine 2001;26:830-4. [DOI:10.1097/00007632-200104010-00027]
3. Hopf S, Buchalla R, Elhöft H, Rubarth O, Börm W. Atypical dislocated dens fracture type II with rotational atlantoaxial luxation after a riding accident. Unfallchirurg 2009;112:517-20. [DOI:10.1007/s00113-008-1542-5]
4. Lenehan B, Guerin S, Street J, Poynton A. Lateral C1-C2 dislocation complicating a type II odontoid fracture. J Clin Neurosci 2010;17:947-9. [DOI:10.1016/j.jocn.2009.11.025]
5. Oh JY, Chough CK, Cho CB, Park HK. Traumatic atlantoaxial rotatory fixation with accompanying odontoid and C2 articular facet fracture. J Korean Neurosurg Soc 2010;48:452-4. [DOI:10.3340/jkns.2010.48.5.452]
6. Spoor AB, Diekerhof CH, Bonnet M, Oner FC. Traumatic complex dislocation of the atlantoaxial joint with odontoid and C2 superior articular facet fracture. Spine 2008;33:E708-11. [DOI:10.1097/BRS.0b013e31817c140d]
7. Gleizes V, Jacquot FP, Signoret F, Feron JM. Combined injuries in the upper cervical spine: clinical & epidemiological data over a 14-year period. Eur Spine J 2000;9:386-92. [DOI:10.1007/s005860000153]
8. Anderson LD, D'Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am 1974;56:1663-74. [DOI:10.2106/00004623-197456080-00017]
9. Roy-Camille R, Saillant G, Judet T, De Botton G, Michel G. Facteurs de gravité des fractures de l'odontoïde. Rev Chir Orthop 1980;66:183-6.
10. Fielding JW, Hawkins RJ. Atlantoaxial rotatory fixation (Fixed rotatory subluxation of the atlantoaxial joint). J Bone Joint Surg Am 1977;59:37-44. [DOI:10.2106/00004623-197759010-00005]
11. Lucas J, Hungerford Jr GD, Perot PL. Treatment of nontraumatic atlantoaxial dislocation and fibrous fusion. J Neurosurg 1982;56:139-42. [DOI:10.3171/jns.1982.56.1.0139]
12. Böhler J. Anterior stabilization for acute fractures and non-:union:s of the dens. J Bone Joint Surg Am 1982;64: 18-9. [DOI:10.2106/00004623-198264010-00004]
13. Botelho RV, de Souza Palma AM, Abgussen CM, Fontoura EA. Traumatic vertical atlantoaxial instability: the risk associated with skull traction. Case report and literature review. Eur Spine J 2000;9:430-3. [DOI:10.1007/s005860000166]
14. Silbergeld DL, Laohaprasit V, Grady MS, Anderson PA, Winn HR. Two cases of fatal atlantoaxial distraction injury without fracture or rotation. Surg Neurol 1991;35:54-6. [DOI:10.1016/0090-3019(91)90203-L]
15. Bahadur R, Goyal T, Dhatt SS, Tripathy SK. Transarticular screw fixation for atlantoaxial instability-modified Magerl's techniquein 38 patients. J Orthop Surg Res 2010;5:87. [DOI:10.1186/1749-799X-5-87]
16. De Andrade JR, Macnab I. Anterior occipitocervical fusion using an extrapharyngeal exposure. J Bone Joint Surg Am 1969;51:1621-5. [DOI:10.2106/00004623-196951080-00011]
17. Barbour J. Screw fixation in fractures of the odontoid process. S Aust Clinics 1971;5:20.
18. Du Toit G. Lateral atlantoaxial arthrodesis. A screw fixation technique. S Afr J Surg 1976;14:9-12.
19. Roy-Camille R, Saillant G, Judet T, Mamoudy P, Feron JM. Lateral atlantoaxial arthrodesis. Rev Chir Orthop Reparatrice Appar Mot 1982;68:139-42.
20. Koller H, Kammermeier V, Ulbricht D, Assuncao A, Karolus S, van den Berg B, et al. Anterior retropharyngeal fixation C1-2 for stabilization of atlantoaxial instabilities: study of feasibility, technical description & preliminary results. Eur Spine J 2006;15:1326-412. [DOI:10.1007/s00586-006-0103-2]
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
