Rotational dislocation of the atlantoaxial joint associated with type 2 odontoid fracture in high energy trauma A case report and review of articles

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Larijani Amirhossein; Baradaran Baqeri Ali; Maleki Hossein; Chavoshi nejad Mehdi; Sarchahi Sina; Khalaji Narges

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Journal Paper

Paper Information

Journal: Alborz University Medical Journal Year:2023 | Volume:12 | Issue:Supplement Page(s): 49-57

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Title

Rotational dislocation of the atlantoaxial joint associated with type 2 odontoid fracture in high energy trauma A case report and review of articles

Author(s)

Keywords

Odontoid fracture

Atlantoaxial rotational dislocation

Occipitocervical stabilization

Abstract

Background: The combination of atlantoaxial joint dislocation and fracture of the odontoid process is a rare but serious spine injury that causes instability. The estimated frequency of this combined injury is less than 2% among upper cervical spine dameges. Few clinical cases of mentioned damage has been reported in scientific resources. In this article, we present the prognosis of a patient with atlantoaxial joint dislocation along with Odontoid fracture and discuss how to manage this type of combined injury. Case presentation: A 19-year-old man presents with a fracture of the C2 axis in the odontoid process and posterior displacement of the atlas vertebra (C1) relative to C2 due to motor vehicle accident. posterior displacement was observed with bilateral dislocation of the lateral joints. Conservative treatment consisted axial traction with a halo head brace was performed to reduce the atlantoaxial dislocation. Because traction failed, we decided to perform surgery to reduce the dislocation and fix the C1-C2 joint. postoperative X-ray and CT scan were satisfactory. At the 6 months follow-up, the clinical picture was stable and the patient had no major functional problems. Dynamic X-ray Showed good range of motion in flexion and extension. Conclusion: The combination of atlantoaxial joint dislocation and fracture of the odontoid process is a rare spine injury that is considered serious due to causing instability. First, we treat the dislocation, then the treatment of the fracture of the odontoid appendage is determined based on the results of displacement and its stability. Conservative treatment of dislocation includes axial traction with a halo head brace. If traction fails, an open reduction should be performed through the posterior approach with C1-C2 Magerl fixation. If this approach is not possible, occipitocervical fixation is performed. The rarely-used lateral approach has an advantage in this indication, because the atlantoaxial joint exposure is excellent and the option exists to perform anterior transarticular fusion.

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