Volume 13 - Supplement, Winter
aumj 2024, 13 - Supplement, Winter: 49-57 |
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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: (795 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
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