title: Management of combined atlas-axis fractures: a review of forty one cases.
abstract: To outline a management principle for the combined atlas (C1)-axis (C2) fractures and assess its therapeutic effects.
  
  
  
  Forty-one patients with combined C1-C2 fractures were treated according to their C2 fracture types. Non-operative external immobilization in the form of a cervical collar or halo vest was used in 22 patients. Early posterior pedicle screw fixations were performed in 19 patients whose fractures had a combination of any of the three conditions: an atlantodens interval (ADI) ≥ 5 mm, lateral mass displacement (LMD) > 7 mm, and/or C2-C3 angulation > 11°. Thirty-nine patients were followed up regularly with an average of 19.3 months (range, 12 to 45 months). Clinical and radiographic data were then collected and compared.
  
  
  
  At three months following treatment, patients' visual analog scale (VAS), Neck Disability Index (NDI), American Spinal Injury Association (ASIA) scale, and Frankel grades were all significantly improved when compared to pretreatment. These results indicated that the cervical collar, halo vest, and posterior pedicle screw fixation approaches were all able to effectively treat cases of combined C1-C2 fractures. One patient in the non-surgical group developed nonunion which required late surgical treatment and one patient had pin site infection in the non-surgical group (2/22), while there were three minor complications in the surgical group.
  
  
  
  We propose a management principle that bases the treatment of a combined C1-C2 fracture on the nature of the C2 fracture. This treatment strategy has yielded promising results as a satisfactory means for the management of combined C1-C2 fractures.
authors.affiliation: Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou, 363000, China. linbin813@163.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Lin
authors.affiliation: Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou, 363000, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou, 363000, China.
authors.forename: Zhi-da
authors.initials: ZD
authors.lastname: Chen
authors.affiliation: Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou, 363000, China.
authors.forename: Wenrong
authors.initials: W
authors.lastname: Zeng
authors.affiliation: Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou, 363000, China.
authors.forename: Qingjun
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Department of Orthopaedics, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou, 363000, China.
authors.forename: LiLin
authors.initials: L
authors.lastname: Dai
mesh_terms: D000328:Adult; D000368:Aged; D001863:Bone Screws / Q000009:adverse effects / Q000706:statistics & numerical data*; D002574:Cervical Vertebrae / Q000293:injuries* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D016103:Spinal Fractures / Q000628:therapy*; D013123:Spinal Fusion / Q000379:methods; D013165:Splints / Q000009:adverse effects / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Combination atlas-axis fractures; Management; Nonoperative treatment; Pedicle screw fixation