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Multiple fractures of the axis are rare and present challenging patterns of instability in cervical spine surgery. Once a surgeon is faced with a combination of fractures in the axis vertebra, including stable and unstable components, a sound treatment concept must be worked out to achieve primary stability, early mobilization, and superior outcome. We demonstrate an operative technique for the stabilization of a 4-part fracture of the axis. Utilizing anterior odontoid screw fixation and C2-3 arthrodesis, an unstable traumatic spondylolisthesis with fracture of the odontoid type IIA, and lateral mass of C2 was successfully stabilized at once. The technique enabled early postoperative mobilization of our patient, who, after 1 year, showed a favorable outcome with a pain-free range of motion. The basic thoughts guiding to treatment options in multiple fractures of the axis are discussed and our therapy concept is presented.

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Traumatic atlantooccipital dislocation (AOD) is a severe injury which functionally separates the head from the spine. Neurological compromise or death is the common sequela. We report on a survivor after AOD, who came back to sportive activities after operative stabilization C0-2. Actually, due to the lack of large single institution series, there are no clearly recommended guidelines concerning diagnostics and treatment of AOD. Overlooking a critical review of literature, the inferences of our case are illustrated and diagnostic as well as operative treatment concepts are discussed.