Epidemiology and management of atlas fractures

Abstract

Purpose The purpose of this study was to gain new insights into the epidemiologic characteristics of patients with atlas fractures and to retrospectively evaluate complication rates after surgical and non-surgical treatment. Methods In a retrospective study, consecutive patients diagnosed with a fracture of the atlas between 01/2008 and 07/2018 were analyzed. Data on epidemiology, concomitant injuries, fracture patterns and complications were obtained by chart and imaging review. Results In total, 189 patients (mean age 72 years, SD 19; 57.1% male) were treated. The most frequent trauma mechanism was a low-energy trauma (59.8%). A concomitant injury of the cervical spine was found in 59.8%, a combined C1/C2 injury in 56.6% and a concomitant fracture of the thoraco-lumbar spine in 15.4%. When classified according to Gehweiler, there were: 23.3% type 1, 22.2% type 2, 32.8% type 3, 19.0% type 4 and 1.1% type 5. Treatment of isolated atlas fractures (n = 67) consisted of non-operative management in 67.1%, halo fixation in 6.0% and open surgical treatment in 26.9%. In patients with combined injuries, the therapy was essentially dictated by the concomitant subaxial cervical injuries. Conclusions Atlas fractures occurred mainly in elderly people and in the majority of the cases were associated with other injuries of the head and spine. Most atlas fractures were treated conservatively. However, surgical treatment has become a safe and valid option in unstable fracture patterns involving the anterior and posterior arch (type 3) or those involving the articular surfaces (type 4).1. Atlas fractures occurred mainly in elderly people and in the majority of the cases were associated with other injuries of the head and spine. 2.A concomitant injury of the cervical spine was found in 59.8 %, a combined C1/C2 injury in 56.6 %.3. Most atlas fractures were treated conservatively. However, surgical treatment has become a safe and valid option in unstable fracture patterns involving the anterior and posterior arch (type 3) or those involving the articular surfaces (type 4).Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Epidemiology of atlas fractures in the United States

“…Consistent with previously published findings, concomitant head and spine injuries were commonly associated with atlas fractures,[ 10 11 25 32 ] with a concomitant fracture of C2 being the most commonly associated fracture. Combined atlantoaxial (C1-C2) fractures have been reported in 19%–56% of cases of atlas fractures,[ 6 11 24 25 26 ] and in the current study was diagnosed in 33.7% of cases. A fracture of the axis was found more frequently in older patients, in accordance with findings in other populations.…”

“…With regard to patient demographic characteristics, the results of the current study are generally consistent with previously published studies of smaller patient populations, although there are some differences. The mean age of patients with atlas fractures has been reported between 49 and 72 years,[ 3 6 10 11 28 ] and in the current study was 70.7 years. The mean age of females was higher than that of males, in accordance with the findings of Matthiessen and Robinson,[ 6 ] who reported a mean age of 59 years for males and 70 years for females.…”

“…Much of the prior work is limited by small numbers of patients or is outdated. [ 2 3 8 9 ] Furthermore, the recent investigations in this area have focused primarily on European patient populations,[ 6 10 11 ] which may not be representative of the patient populations in other countries. Matthiessen and Robinson[ 6 ] recently documented the epidemiology of atlas fractures in Sweden using a national registry and found that the annual incidence more than doubled over the course of the 15-year study period from 1997 to 2011.…”

Anterior reduction and C1-ring osteosynthesis with Jefferson-fracture reduction plate (JeRP) via transoral approach for unstable atlas fractures

“…There is also a point that it was atlas fractures, instead of C1 posterior arch fractures, that destroyed the stability of the upper cervical spine. The displacement of bone fragments or atlantoaxial dislocation puts the spinal cord in danger and can result in severe complications like paraplegia or even death [ 8 , 9 ]. The goal of the treatment is to reduce the fracture, correct dislocated fracture, stabilize the atlantoaxial joint, and preserve the maximum ROM of the upper cervical spine [ 10 , 11 ].…”

Odontoi̇d Fraktür Yöneti̇mi̇: Kli̇ni̇k Deneyi̇m

“…Bu bölge kırıklarının %56'sında servikal spinal kord hasarı da eşlik etmektedir (1,2). Mortalite oranı %5-10'dur (3,4). Hastaların çoğunda hareketle artan ağrı şikayeti bulunmaktadır.…”