C1-C2 Fracture with atlantoaxial subluxation. 2013 Jun 1. Once accomplished, bilateral pedicle fractures can be addressed with C2 transpedicular screws, or treated conservatively with traction or a halo/vest. C2 fractures were diagnosed and further evaluated in Pas-tor Hospital, Bam, Iran. One patient was lost to follow-up and excluded from the treatment analysis due to untraceable relocation. Combined C1 & C2 #s • Common • Accompanying C2 injuries • ttt is based on the nature of the C2 fracture • External immobilization is recommended %Injury 40%Type 2 dens fracture 20%Type 3 dens fracture 12%Hangman’s fracture 28%other 46. In Sweden all patient contacts within the public healthcare system are registered prospectively in a national patient registry with unique personal identification number and diagnosis codes using the 10th version of the International Classification of Diagnosis (ICD-10) [13]. Of Hangman’s fractures 54% were treated surgically. During the 13 years of this study the population in Uppsala County and Malmö municipal increased from 432,293 in 2002 to 519,152 in 2014, with a mean age of 39.6 years in 2002 and 39.4 years in 2014. Management of acute odontoid fractures: operative techniques and complication avoidance. Whether there is a correlation between elderly care and risk of C2 fractures is not investigated, yet, and warrants further research. Vaccaro et al, in a study of 159 elderly patients with type II dens fractures, reported a significant benefit with surgical treatment and recommended that elderly patients with such fractures who are healthy enough for general anesthesia be considered for surgical stabilization. Common hardware failures include screw bending and breaking, loosening of implants, and hardware failure secondary to osteoporotic bone. How is a compression fracture diagnosed? Le risque de fracture des vertèbres cervicales est que dans 80% des cas ce traumatisme entraîne des conséquences neurologiques. These are the most common hangman’s fracture type and result from hyper-extension with axial loading followed by hyperflexion. 2009 Jun. 18 (7):978-91. [Medline]. James F Kellam, MD, FRCSC, FACS, FRCS(Ire) Professor, Department of Orthopedic Surgery, University of Texas Medical School at Houston Surgical and nonoperative treatments are associated with high complication and mortality rates, and these rates have not been evaluated at the population level, to our knowledge. 22 (2):91-5 Cervical crossing laminar screws: early clinical results and complications. Three patients in the nonsurgical group were treated with a halo-vest, one O2 and two A. In the absence of high-level evidence, the treatment rationale of odontoid fractures type II of the elderly has been a matter of debate. Eur Spine J. Objective: To estimate the incidence and to describe the clinical results of the nonoperative management of vertical C2 body fractures. 2002 233 patients (female 51%, age years) were treated for a C2 fracture. Displacement of less than 20% is acceptable. 3). Upper cervical spine injuries: a management of a series of 70 cases. 74 (2):276-81. 2007 Jul. In this study a trend towards surgical management was found, as well. Treatment ranges from collar immobilization for uncomplicated minimally depressed fractures to cervical traction followed by halo immobilization for more extensive fractures. C2 Fracture Recovery Time Elderly . A xis (C2) fractures compose the majority of cervical spine fractures in patients age >80 years. The age group < 70 consisted of 70 patients (20 women), with a mean age of years. 2011 Aug 15. J Trauma. Possibly, most atypical C2 fractures require a high-energy injury mechanism, and are thus more represented within the younger age group [9, 10, 26]. V. Sangüesa Sánchez. Level of Fracture C1 59 (36.6) C2 116 (72.0) C3 18 (11.2) C4 20 (12.4) C5 29 (18.0) C6 43 (26.7) C7 46 (28.6) Mechanism of Injury Fall 131 (81.4) Motor vehicle collision 24 (14.9) Other 6 (3.73) Dysphagia Y/N 42 (26.1) OD was present in 42 patients (26.1%) versus 119 (73.9%) patients without OD. [Medline]. Spine (Phila Pa 1976). Background: Cervical 2 (C2) fractures in the elderly are common, and the incidence of these fractures has been increasing. However, some reports have demonstrated nonunion rates approaching 80% in certain subsets of patients. 2008 Apr. 2008 Apr. The currently available data on the distribution of C2 fracture subtypes is sparse. Distribution of C2 fractures divided into patients < 70 years and ≥70 years of age (%). [10, 16, 20–22]. 2008 Aug. 31 (8):818. Nonunion, malunion, and pseudarthrosis formation are potential major complications. Lateral mass plating of C2 by placing lateral mass screws in C3 in conjunction with C2 transpedicular screws may make postoperative halo immobilization unnecessary. This review is based on a presentation given by Adam Flanders and adapted for the Radiology Assistant by Robin Smithuis. Knowledge of these proportions facilitates future epidemiological studies of C2 fractures. These data suggest that percutaneous anterior screw fixation may be a safe and reliable alternative with potential advantages for treatment of type II and rostral type III odontoid fractures. The AOSpine North America Geriatric Odontoid Fracture Mortality Study: a retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up. Curr Probl Diagn Radiol. Neurovascular injury is a risk associated with any surgical intervention and is a function of both surgical acumen and anatomic variability. A value < 0.05 was considered as statistically significant. Exactly the same distribution has been recently published in a cohort of 41 patients with Hangman’s fractures, where 54% were type 1 and 46% type 2 according to Al-Mahfoudh et al. Knowledge of the practice of the different types of C1-C2 and C2 screw fixations is indispensable. A comminuted fracture is a breakage of the bone into more than two fragments. WHILE YOU ARE HERE: Informed consent. Repeated imaging is used to monitor the healing process with a variable time course. Odontoid fractures are the most common fracture of the axis and are the most common type of cervical spine fracture in patients over 65. [Full Text]. (Reprinted with permission from [1]) Fig. Igor Boyarsky, DO, FACEP, FAAEM Emergency Room Physician, Kaiser Permanente Southern California Effects of age group and gender on treatment allocation and C2 fracture distribution were tested with Chi-square test. With only 26 cases in our cohort, the plotted distribution of Hangman’s fracture subtypes lacks detail (Figure 2). [18]  In this study, operative treatment had a significant advantage in 30-day survival advantage, and a trend toward improved longer-term survival was noted. This fracture can occur in younger children but is less common than fractures of C1 and the odontoid process. Back to top. The currently available data on the distribution of C2 fracture subtypes is sparse. A fracture of the C2 vertebra is known as a hangman’s fracture or axis vertebra fracture. A cervical fracture, commonly called a broken neck, is a fracture of any of the seven cervical vertebrae in the neck.Examples of common causes in humans are traffic collisions and diving into shallow water. During our radiographic analysis and patient history screening, no cases had to be excluded as false-positive, confirming the quality of diagnosis coding. While plain radiographs miss about 23% of cervical spinal injuries [41], CT protocols, as used in our department, have near 100% sensitivity for cervical injuries [42]. Since both hospitals are the only spinal fracture care providers in their respective region, it can be assumed that the coverage is comprehensive. Type II fractures can be managed conservatively or surgically. Pratt H, Davies E, King L. Traumatic injuries of the c1/c2 complex: computed tomographic imaging appearances. In a hangman’s fracture, the pars of C2 fractures, or breaks, on both sides. But still, they are not invincible. This study presents reliable age specific proportions and incidences of C2 fractures subtypes in a comprehensive regional dataset. The same trend has been shown in some earlier studies [12, 27, 28]. There was a higher proportion of odontoid fractures type 3 among elderly compared to the younger age group (Figure 1). Annual incidence of odontoid fractures (all types) in patients ≥ 70 years (dotted), divided into subgroups of odontoid fracture type 2 (orange) and type 3 (grey) during the years 2002 to 2014. A classification based on the analysis of 131 cases,”, M. E. Dunn and E. L. Seljeskog, “Experience in the management of odontoid process injuries: an analysis of 128 cases,”, A. D. Hanssen and M. E. Cabanela, “Fractures of the dens in adult patients,”, E. Fujii, K. Kobayashi, and K. Hirabayashi, “Treatment in fractures of the odontoid process,”, A. M. Levine and C. C. Edwards, “The management of traumatic spondylolisthesis of the axis,”, F. P. Ferro, G. D. Borgo, O. A fracture occurs when a bone cannot withstand an outside force like a direct blow or fall. Traumatic Spondylolisthesis of C2 (Hangman Fracture) Hangman fracture is a hyperextension injury of the cervical spine. 33 (3):255-8. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Odontoid C2 Fracture To establish the population-at-risk in the various age and gender groups, population data was retrieved from Statistics Sweden, an administrative agency providing statistics to government and researchers. Les vertèbres C1 et C2 sont les première et deuxième vertèbres cervicales, elles sont nommées respectivement l'atlas et l'axis. C2 Fracture Treatment . Selecciona Tus Preferencias de Cookies. This study was designed to identify the proportions of the second cervical vertebra (C2) fracture subtypes and to present age and gender specific incidences of subgroups. In Sweden the proportion of institutionalised elderly decreases, while more depend on home-care services [31]. fracture. C2 Fracture Subtypes, Incidence, and Treatment Allocation Change with Age: A Retrospective Cohort Study of 233 Consecutive Cases, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden, Stockholm Spine Center, Stockholm, Sweden, Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden, Annual incidence (per 100,000 person-years) 2002–2014, M. D. Ryan and T. K. F. Taylor, “Odontoid fractures in the elderly,”, S. A. Malik, M. Murphy, P. Connolly, and J. O'Byrne, “Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients,”, E. J. Müller, M. Wick, O. Russe, and G. Muhr, “Management of odontoid fractures in the elderly,”, K. Brolin, “Neck injuries among the elderly in Sweden,”, J. W. Pepin, R. B. Bourne, and R. J. Hawkins, “Odontoid fractures, with special reference to the elderly patient,”, J. W. Tee, C. H. Chan, M. C. Fitzgerald, S. M. Liew, and J. V. Rosenfeld, “Epidemiological trends of spine trauma: an Australian level 1 trauma centre study,”, C. Matthiessen and Y. Robinson, “Epidemiology of atlas fractures—a national registry-based cohort study of 1,537 cases,”, F. M. Lomoschitz, C. C. Blackmore, S. K. Mirza, and F. A. Mann, “Cervical spine injuries in patients 65 years old and older: epidemiologic analysis regarding the effects of age and injury mechanism on distribution, type, and stability of injuries,”, F. Kandziora, K. Schnake, and R. Hoffmann, “Injuries to the upper cervical spine: Part 2: osseous injuries,”, K. A. Greene, C. A. Dickman, F. F. Marciano, J. C2 Fracture Symptoms . 80 (2):106-13. 2012 Jan 1. 2013. A case study. Fractures can also occur, however, in a variety of other settings. The fracture causes damage to the spinal cord which leads to paralysis of respiratory muscles and most often death1. Fractures de C2 Fracture du corps de C2 Fracture de l’arc postérieur de C2 Fracture de l’odontoïde. In this study the Hangman’s fracture subgroups were evenly distributed with 54% type 1 and 46% type 2. This relatively small proportion should not have affected the distribution or the incidence of C2 fractures in our study population, since most of these patients will eventually be referred to radiological diagnostics, and will then appear in one of the spine surgical departments. The patients were subdivided according to age classes, <70 and ≥70 years. [Medline]. [Medline]. The fracture is caused by an extreme force on the upper vertebrae and especially on the dens of the axis. Jeffrey A Goldstein, MD Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Director of Spine Service, Director of Spine Fellowship, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, NYU Langone Medical Center [22]. With this study the previously published distribution of C2 fracture subgroups has been validated, and new values for subgroup proportions presented for regions in Sweden. Your healthcare provider will talk to you about your medical history and recent injuries and do a physical exam. Es común en los niños. L. D. Anderson and R. T. D'Alonzo, “Fractures of the odontoid process of the axis,”, J. N. Grauer, B. Shafi, A. S. Hilibrand et al., “Proposal of a modified, treatment-oriented classification of odontoid fractures,”, B. Effendi, D. Roy, B. Cornish, R. G. Dussault, and C. A. Laurin, “Fractures of the ring of the axis. Wang MY. Koller H, Acosta F, Tauber M, Komarek E, Fox M, Moursy M, et al. Consequently, a change in distribution and incidence of the various fracture types towards typical osteoporotic fractures can be anticipated [12]. C1 fractures should be promptly identified and treated in all patients although they rarely require surgery. In this case, surgical reduction and stabilization is mandated and is accomplished with lateral mass plates, interspinous wiring, or bilateral oblique wiring. Anna-Lena Robinson, Anders Möller, Yohan Robinson, Claes Olerud, "C2 Fracture Subtypes, Incidence, and Treatment Allocation Change with Age: A Retrospective Cohort Study of 233 Consecutive Cases", BioMed Research International, vol. Older adults are at increased risk of C2 fractures, a serious injury that requires prompt treatment to prevent injury to the cervical (neck) portion of the spinal cord. 2013. Conséquences de la fracture vertébrale cervicale. In Sweden, in case of cervical injuries, the responsible level-one trauma centre is always contacted, and the cervical injury thus registered with this centre. There was a difference between the two age groups with regard to fracture classification and gender (). Complications of C2 fracture treatment include nonunion, malunion, pseudoarthrosis formation, infection, neurovascular injury, acute airway compromise, and hardware failure. The types and proportion of this specific C2-fracture subgroup have not yet been thoroughly investigated. Cho DC, Sung JK. Cervical spine trauma: unstable fractures, C2-C7 injuries, and imaging guidelines. Malunion is a potential complication. Improved motor vehicle safety and protective gear have reduced the incidence of spinal injuries in the younger population [2]. In the patient in this case, traumatic injury triggered by a syncopal event led to a combined C1-C2 fracture and a fatal spinal cord injury with apnea, quadriplegia, and cardiovascular instability. From 2002 to 2014 we could observe an increase in the odontoid fractures type 2 incidence, from 7 to 16 per 100,000 person-years. Subgroup proportions of Hangman’s fractures are in 29–72% type 1, 28–69% type 2, and 0–10% type 3 classified according to Effendi et al. Paolo et al examined 108 consecutive type II fractures, of which 60 were conservatively treated with external immobilization and 48 surgically treated . The treatment rationale of odontoid fractures type 3 in our study followed these recommendations. Treatment options for type IIA fractures include both conservative and surgical measures. Levine and Edwards classification is used to classify hangman fractures of C2 (also known as traumatic spondylolisthesis of axis).. C1 And C2 Fracture Prognosis . The risks of nonunion, malunion, and pseudoarthrosis formation are lessened with surgical treatment. Too much force can break them into pieces. Osteomyelitis is a rare, but not unknown, complication. Patients with odon-toid fracture, hangman’s fracture, pars interarticularis or facet fractures were excluded, as were C2 body fractures associated with fractures elsewhere in the cervical spine (e.g., C1). C2-fractures: part I. Quantitative morphology of the C2 vertebra is a prerequisite for the radiographic assessment of posttraumatic C2-alignment and the investigation of clinical outcomes. Type 2 fractures—Type 2 fractures include disruption of the C2–3 disk with anterior translation of the C2 body. No correlation was found for other C2 fracture subtypes. Regarding treatment of Hangman’s fracture type 1, nonsurgical treatment with a rigid collar was dominating. 1264627-overview [15]. Copyright © 2017 Anna-Lena Robinson et al. The C6 fracture can be best visualized on the coronal image, where the inferior articular process has a breach in cortex, with mild angulation. Complications of C2 fracture treatment include nonunion, malunion, pseudoarthrosis formation, infection, neurovascular injury, acute airway compromise, and hardware failure. Your response will be added to our survey results below. We therefore assume that very few injuries were missed in our cohort. William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Kentucky Medical Association, North American Spine Society, Kentucky Orthopaedic Society, International Society for the Study of the Lumbar Spine, Southern Medical Association, Southern Orthopaedic AssociationDisclosure: Received royalty from DePuySpine 1997-2007 (not presently) for consulting; Received grant/research funds from DePuySpine 2002-2007 (closed) for sacropelvic instrumentation biomechanical study; Received grant/research funds from DePuyBiologics 2005-2008 (closed) for healos study just closed; Received consulting fee from DePuySpine 2009 for design of offset modification of expedium. The proportion of surgically treated odontoid fractures type 2 increased during the last decade in Uppsala and Malmö, which follows the recent development of recommendations. Deep, displaced, or angulated fractures are treated with closed reduction and halo thoracic immobilization. C2 fracture “Hangman’s fracture” is the colloquial name for a traumatic spinal cord injury that affects the axis vertebrae.