title: Surgical management of the fractures of axis body: indications and surgical strategy.
abstract: OBJECTIVE
  The axis body fractures are relatively uncommon and have a variety of presentations. Surgical management to them has been only reported as case reports or included as a minor part of clinical management. The objective of this study is to summarize the indications for surgery and report the clinical outcome of surgical treatment based on different fracture patterns.
  
  
  METHODS
  A retrospective analysis of 28 consecutive patients presenting with the axis body fractures was undertaken. The indications for surgical treatment were defined as: (1) fractures associated with instability of adjacent joints; (2) irreducible displaced superior articular facet fracture; (3) fractures resulting in spinal cord compression. The fractures were classified as sagittal, coronal, transverse and lateral mass fracture. One of the following surgical procedures was applied according to the fracture pattern: posterior C1-C2 pedicle screws fixation and fusion (I); posterior C1-C3 screws fixation and fusion (II); posterior osteosynthesis with C2 transpedicular half-thread lag screws (III).
  
  
  RESULTS
  13 patients were successfully managed operatively. Two transverse and two unilateral lateral mass fractures were treated with surgical procedure I, five sagittal fractures with II, four coronal fractures with III. Complications of malposition of screws and neurologic deficit did not occur during operation. Satisfactory reduction and bony union were demonstrated on postoperative radiographics.
  
  
  CONCLUSIONS
  Conservative treatment is still advocated as primary management for most axis body fractures. But for patients with obvious adjacent joints instability or irreducible displaced superior articular facet fracture, surgical intervention based on the different fracture pattern is necessary.
authors.affiliation: Department of Orthopaedics, The First Affiliated Hospital of AnHui Medical University, 218 Jixi Road, Shushan District, Hefei, Anhui, 230022, China, zhangyinshun@126.com.
authors.forename: Yin-Shun
authors.initials: YS
authors.lastname: Zhang
authors.forename: Jian-Xiang
authors.initials: JX
authors.lastname: Zhang
authors.forename: Qing-Guo
authors.initials: QG
authors.lastname: Yang
authors.forename: Cai-Liang
authors.initials: CL
authors.lastname: Shen
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Zong-Sheng
authors.initials: ZS
authors.lastname: Yin
mesh_terms: D000328:Adult; D001368:Axis, Cervical Vertebra / Q000293:injuries* / Q000601:surgery*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D065289:Pedicle Screws; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000601:surgery; D016103:Spinal Fractures / Q000175:diagnosis* / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D055815:Young Adult