title: Management of combination fractures of the atlas and axis in adults.
abstract: There is insufficient evidence to support treatment standards.
  
  
  
  There is insufficient evidence to support treatment guidelines.
  
  
  
  Treatment of atlas-axis combination fractures based primarily on the specific characteristics of the axis fracture is recommended. External immobilization of most C1--C2 combination fractures is recommended. C1--Type II odontoid combination fractures with an atlantodens interval of 5 mm or more and C1--hangman's combination fractures with C2--C3 angulation of 11 degrees or more should be considered for surgical stabilization and fusion. In some cases, the surgical technique must be modified as a result of loss of the integrity of the ring of the atlas.
authors.forename: M N
authors.initials: MN
authors.lastname: Hadley
authors.forename: B C
authors.initials: BC
authors.lastname: Walters
authors.forename: P A
authors.initials: PA
authors.lastname: Grabb
authors.forename: N M
authors.initials: NM
authors.lastname: Oyesiku
authors.forename: G J
authors.initials: GJ
authors.lastname: Przybylski
authors.forename: D K
authors.initials: DK
authors.lastname: Resnick
authors.forename: T C
authors.initials: TC
authors.lastname: Ryken
mesh_terms: D000328:Adult; D001368:Axis, Cervical Vertebra / Q000293:injuries* / Q000601:surgery; D001270:Cervical Atlas / Q000293:injuries* / Q000601:surgery; D019317:Evidence-Based Medicine; D006801:Humans; D007103:Immobilization; D009809:Odontoid Process / Q000293:injuries* / Q000601:surgery; D017410:Practice Guidelines as Topic / Q000592:standards; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion