Die traumatische atlantoaxiale Rotationsfehlstellung mit Gelenkfortsatzfraktur des Axis

Abstract

Traumatic atlanto-axial rotatory fixation (AARF) is a relatively uncommon injury, especially in association with fractures of the axis. The rotatory dislocation and fixation is normally caused by intercalated facet joints of axis and atlas. A traumatic AARF in a 21 year old female is presented with special emphasis on the diagnostic and therapeutic approaches. This high velocity injury was caused by a traffic accident. The trauma service which was initially involved made the correct diagnosis and tried to reduce the dislocation by skull traction during analgesia and sedation, but without success. For further treatment, the patient was referred to a level one trauma center. After completing the diagnostic imaging with MRI and CT for exact delineation of the fracture site and determination of ligament damage, a halo fixation for skull traction was installed. This second attempt was also unsuccessful. Only a closed reduction under general anesthesia with muscle relaxation led to a neutral alignment and congruent joint contact between C1 and C2. Due to the stable fracture site and the intact ligaments, a conservative treatment with a stable collar splint was performed.

Die instabile traumatische Spondylolisthese C2/3 - Ergebnisse und Empfehlungen nach operativer Stabilisierung in 34 Fällen und Literaturübersicht

“…Facettenluxationen sind häufig von Diskusherniationen begleitet [7,160]. Beim Bewusstlosen muss aber nicht nur bei einer vorliegenden Luxation nach ausgesprengten Diskus-und oder Knochensequestern in CT/MRT [110,231] [70,213]. Der Erfolg hängt dann maßgeblich von der Intaktheit atlantoaxialer Kapselstrukturen und Mm.…”

“…Ein Patient mit TS C2-3 verstarb unter Traktion an Aspiration von Erbrochenem [255], ein anderer infolge respiratiorischer Komplikation [203]. Scheint dennoch eine gedeckte Reposition indiziert, ist die manuelle Technik zu favorisieren [1, 25,213]. Die Traktion ist generell gefährlich!…”

Traumatic atlantoaxial rotatory fixation associated with C2 articular facet fracture in adult patient: Case report

“…AARF can also be associated with fractures, due to a combination of bone and ligament disruption but this association is very rare; C2 fractures are relatively the most frequently founded, and only six such cases have been reported in the literature[ 8 9 ]; but AARF in combination with an articular facet fracture, like in our case, is an extremely rare injury and to the best of our knowledge only Seybold described similar case. [ 10 ] However, because of the complexity and heterogeneity of these fractures, they are usually lumped under the descriptive category of “miscellaneous C2 fractures” in most published reports. [ 8 ]…”