gms | German Medical Science

Objective: Combined traumatic injuries of atlas and dens axis are diagnostic and therapeutic challenges – rarely reported and not yet systematically classified. Within 12 months five trauma patients presented to our department of neurosurgery with an atlantodental fracture which cannot be classified. These cases raise the question about the necessity of a new classification for combined C1 and C2 fractures.

Method: In our cross- regional trauma centre, all polytrauma patients are screened by means of a whole body spiral CT scan with a 64 row CT scanner. The mean scan time for the whole body spiral CT is about 20 sec with a dose length product of about 1800 x cm mGY followed by standardized 3D reconstructions of every anatomical region.

Results: From August 2011 to August 2012 115 whole body spiral CT scans have been performed. We detected five patients with combined fractures of atlas and axis. Despite differences in circumstances of the accident, all fractures had a similar pattern and could not be categorized by any known classification. This pattern ressembled a combination of a dens axis fracture type III according to Anderson/D'Alonzo (1974) and an atlas fracture type I and III, respectively, according to Gehweiler (1979) and Jefferson (1920). Three Patients were primarily stabilized with halo yoke – immobilization for 3 months. One of them has been treated surgically in the further course. Two patients received conservative treatment.

Conclusions: It appears that the numbers of patients with isolated injuries of the upper cervical spine is decreasing due to improved CT imaging with whole body 3D data acquisition. On the contrary the detection of more complex fracture patterns is obviously increasing. Apparently an update of the conventional classification for fractures of the craniocervical junction is required. In this respect particular attention should be paid to combined injuries in the upper cervical spine.