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Direct Internal Fixation for Unstable Atlas Fractures

 Jae-Won Shin  ;  Kyung-Soo Suk  ;  Hak-Sun Kim  ;  Jae-Ho Yang  ;  Ji-Won Kwon  ;  Hwan-Mo Lee  ;  Sung-Hwan Moon  ;  Byung-Ho Lee  ;  Sang-Jun Park  ;  Sub-Ri Park  ;  Sun-Kyu Kim 
 YONSEI MEDICAL JOURNAL, Vol.63(3) : 265-271, 2022-03 
Journal Title
Issue Date
Bone Screws ; Cervical Atlas* / diagnostic imaging ; Cervical Atlas* / injuries ; Cervical Atlas* / surgery ; Fracture Fixation, Internal / methods ; Humans ; Retrospective Studies ; Spinal Fractures* / diagnostic imaging ; Spinal Fractures* / surgery
Neck injury ; cervical atlas ; cervical vertebrae ; spinal fractures ; spinal injuries
Purpose: To investigate the radiologic and clinical outcomes of direct internal fixation for unstable atlas fractures.

Materials and methods: This retrospective study included 12 patients with unstable atlas fractures surgically treated using C1 lateral mass screws, rods, and transverse connector constructs. Nine lateral mass fractures with transverse atlantal ligament (TAL) avulsion injury and three 4-part fractures with TAL injury (two avulsion injuries, one TAL substance tear) were treated. Radiologic outcomes included the anterior atlantodental interval (AADI) in flexion and extension cervical spine lateral radiographs at 6 months and 1 year after treatment. CT was also performed to visualize bony healing of the atlas at 6 months and 1 year. Visual Analog Scale (VAS) scores for neck pain, Neck Disability Index (NDI) values, and cervical range of motion (flexion, extension, and rotation) were recorded at 6 months after surgery.

Results: The mean postoperative extension and flexion AADIs were 3.79±1.56 (mean±SD) and 3.13±1.01 mm, respectively. Then mean AADI was 3.42±1.34 and 3.33±1.24 mm at 6 months and 1 year after surgery, respectively. At 1 year after surgery, 11 patients showed bony healing of the atlas on CT images. Only one patient underwent revision surgery 8 months after primary surgery due to nonunion and instability findings. The mean VAS score for neck pain was 0.92±0.99, and the mean NDI value was 8.08±5.70.

Conclusion: C1 motion-preserving direct internal fixation technique results in good reduction and stabilization of unstable atlas fractures. This technique allows for the preservation of craniocervical and atlantoaxial motion.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kwon, Ji-Won(권지원) ORCID logo https://orcid.org/0000-0003-4880-5310
Kim, Hak Sun(김학선) ORCID logo https://orcid.org/0000-0002-8330-4688
Moon, Seong Hwan(문성환)
Park, Sang-Jun(박상준)
Park, Sub-Ri(박섭리)
Suk, Kyung Soo(석경수) ORCID logo https://orcid.org/0000-0003-0633-2658
Shin, Jae Won(신재원) ORCID logo https://orcid.org/0000-0002-6656-6336
Yang, Jae Ho(양재호) ORCID logo https://orcid.org/0000-0001-7421-2805
Lee, Byung Ho(이병호) ORCID logo https://orcid.org/0000-0001-7235-4981
Lee, Hwan Mo(이환모) ORCID logo https://orcid.org/0000-0002-5405-3832
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