Irreducible Atlanto-Axial Dislocation in Neglected Odontoid Fracture Treated with Single Stage Anterior Release and Posterior Instrumented Fusion.
It is a well-know fact that type 2 odontoid fractures frequently go into nonunion. If left untreated, patients may develop irreducible atlantoaxial dislocation (AAD). We describe the surgical management of two patients with neglected odontoid fractures and irreducible AAD treated with single stage anterior release followed by posterior instrumented fusion. Both patients presented with history of neglected trauma and progressive myelopathy. Traction under anesthesia failed to achieve reduction of AAD. Anterior release was done by trans-oral approach in one patient and retrophayngeal approach in the other. Posterior fixation was performed with transarticular screws in both the patients. Both patients had full neurological recovery and demonstrated fusion at follow-up. Anterior release followed by posterior instrumented correction may be an effective alternative to the traditional means of treating irreducible dislocations associated with neglected odontoid fractures.
Department of Orthopaedics, Seth G.S. Medical college and K.E.M. Hospital, Maharashtra, India.
Rishi Anil
RA
Aggarwal
Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Maharashtra, India.
Ashok Keshav
AK
Rathod
Department of Orthopaedics, Sir HN Reliance Hospital and Research Center, Maharashtra, India.
Kshitij Subhash
KS
Chaudhary
Atlantoaxial dislocation; Atlantoaxial joint; Dislocation; Neglected; Odontoid process