title: Acute traumatic fractures to the craniovertebral junction: preliminary experience with the "MILD" score scale.
abstract: OBJECTIVE
  Traumatic fractures to the craniovertebral junction (CVJ) are rare events requiring complex clinical management. Several classification systems are currently in use; however, recent improvements of junctional knowledge has focused attention on the role of ligaments and membranes in vertebral biomechanical stability. The aim of this study was to present our preliminary experience with the "MILD" score scale, which should allow fast and effective classification of all CVJ traumatic fractures based on vertebral instability in the acute setting.
  
  
  METHODS
  A prospective study was conducted on 38 consecutive patients with 43 traumatic junctional fractures identified by computed tomography (CT) scan in the acute trauma phase. The MILD scale was applied to all fractures, and a score was obtained for each patient. All cases underwent magnetic resonance imaging (MRI) to assess the anatomical integrity of ligaments and membranes.
  
  
  RESULTS
  Twenty-seven patients (71 %) were classified as MILD type 1 (0-1 points), showed a negative MRI, and healed with conservative treatment. Eight patients (21 %) were classified as MILD type 2 (2 points) and showed modest indirect signs of ligamentous injuries. Four of these patients healed with conservative treatment, while three patients underwent surgery due to wide bone fracture fragment displacement. Three patients (8 %) were classified as MILD type 3 (3 points), all of whom showed extensive ligamentous damage and underwent surgery.
  
  
  CONCLUSIONS
  The close association between the MILD scale and spinal instability is promising, although further studies are warranted in order to confirm our preliminary data.
authors.affiliation: Department of Neurosurgery, Ospedale Niguarda Cà Granda, P.zza Ospedale Maggiore, 3, 20162, Milan, Italy. albertodebernardi@hotmail.it.
authors.forename: A
authors.initials: A
authors.lastname: Debernardi
authors.affiliation: Department of Nursing Education, San Paolo Hospital, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Sala
authors.affiliation: Department of Neurosurgery, Ospedale Niguarda Cà Granda, P.zza Ospedale Maggiore, 3, 20162, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: D'Aliberti
authors.affiliation: Department of Neurosurgery, Ospedale Niguarda Cà Granda, P.zza Ospedale Maggiore, 3, 20162, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Talamonti
authors.affiliation: Department of Neurosurgery, Ospedale Niguarda Cà Granda, P.zza Ospedale Maggiore, 3, 20162, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Cenzato
keywords: Craniovertebral junction; Fractures; Ligaments; Spine; Stability; Trauma
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