title: Treatment of dens fractures with posterior atlantoaxial dislocation with transoral atlantoaxial reduction plate surgery: case report and introduction of a novel treatment option.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To describe a rare old dens fracture with posterior atlantoaxial dislocation that was treated with transoral atlantoaxial reduction plate surgery.
  
  
  BACKGROUND
  Dens fractures with posterior atlantoaxial displacement are not common and cause ventral compression of the spinal cord. Management of this type of fracture is through skull traction and external fixation, posterior laminectomy and fusion, or transoral reduction and posterior fusion.
  
  
  METHODS
  A 38-year-old man sustained a car accident and was diagnosed with type II dens fractures (the classification system of Anderson and D'Alonzo) and posterior atlantoaxial dislocation. The neurological function of the patient was C grade according to the standard neurological classification of spinal cord injury from the American Spinal Association. Because of multiple trauma involving the head, lung, and the abdomen, he was treated with skull traction with about 10° of flexion. No signs of reduction were observed. The patient was treated operatively 70 days after the injury. We performed a transoral atlantoaxial reduction plate surgery using a transoral approach for release, reduction, and fixation. Finally, anterior fusion with iliac bone graft was applied.
  
  
  RESULTS
  Complete atlantoaxial reduction and decompression of the spinal cord were achieved. The patient felt better after surgery. Movement of his extremities raised from grade II-III force to grade IV-V, and neurological status improved from American Spinal Association grade C to D.
  
  
  CONCLUSIONS
  The treatment option achieved instant reduction, decompression, and fixation. A new treatment option for this type of injury is recommended.
authors.affiliation: Department of Orthopedics, Liuhuaqiao Hospital, Guangzhou, People's Republic of China.
authors.forename: Kai
authors.initials: K
authors.lastname: Zhang
authors.forename: JunJie
authors.initials: J
authors.lastname: Xu
authors.forename: Qing
authors.initials: Q
authors.lastname: Wang
authors.forename: GaoJu
authors.initials: G
authors.lastname: Wang
authors.forename: ZengHui
authors.initials: Z
authors.lastname: Wu
authors.forename: Hong
authors.initials: H
authors.lastname: Xia
authors.forename: Qing Shui
authors.initials: QS
authors.lastname: Yin
mesh_terms: D000328:Adult; D001268:Atlanto-Axial Joint / Q000293:injuries* / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods*; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D008297:Male; D009809:Odontoid Process / Q000293:injuries* / Q000601:surgery; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome