title: Conservative treatment of neural arch fractures of the axis: computed tomography scan and X-ray study on consolidation time.
abstract: BACKGROUND
  Computed tomography (CT) scan and X-ray study on consolidation time of C2 neural arch fractures treated conservatively were examined.
  
  
  METHODS
  A prospective study was undertaken: 28 conservatively treated fractures of the neural arch of the axis (11 hanged-man type I, 5 type II, and 12 miscellaneous fractures) were monitored during the period of orthosis by means of CT scan and plain X-rays performed on admission, and then at intervals between 2 and 120 days afterward. In patients treated with a halo vest (20 cases), a CT scan of the skull was performed to make sure that the pins were correctly positioned and to evaluate the osteolytic processes at the pin-bone interface.
  
  
  RESULTS
  Two patients died as a result of other severe brain or thoracoabdominal injuries, and the remaining 26 fractures healed in an average time of 109 days (range 90-120). The process of bone consolidation was documented in detail by CT, which showed how the newly formed osteofibrous tissue (iso-hypodense) progressively filled the interfragmentary space. In 2 cases of cranial pin loosening, CT demonstrated an osteolytic rim at the interface, which prompted early removal of the halo system. At clinical follow-up (mean 32 months; range 24-84), functional status was evaluated: all of the patients were neurologically intact with the exception of one, who presented with persistent paresthesias. The most frequent disturbance was cervical pain (12 cases, 46%).
  
  
  CONCLUSIONS
  CT with two- and three-dimensional reconstructed images has been shown to be the most reliable method for clarifying the evolution of bone consolidation and to show any osteolytic processes at the pin-bone interface during halo vest immobilization. Follow-up results of our series suggest that surgical treatment would not have improved the quality of life in these patients.
authors.affiliation: Orthopaedic Service, Don Gnocchi Foundation of Rome, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ramieri
authors.forename: Maurizio
authors.initials: M
authors.lastname: Domenicucci
authors.forename: Alessandro
authors.initials: A
authors.lastname: Landi
authors.forename: Emanuela
authors.initials: E
authors.lastname: Rastelli
authors.forename: Antonino
authors.initials: A
authors.lastname: Raco
mesh_terms: D000328:Adult; D000368:Aged; D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging* / Q000293:injuries*; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult