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Abstract
Craniocervical injuries (CCJs) account for 10% to 30% of all cervical spine trauma. An increasing number of patients are surviving these injuries due to advancements in automobile technology, resuscitation techniques, and diagnostic modalities. The leading injury mechanisms are motor vehicle crashes, falls from height, and sports-related events. Current treatment with urgent rigid posterior fixation of the occiput to the cervical spine has resulted in a substantial reduction in management delays expedites treatment of CCJ injuries. Within CCJ injuries, there is a spectrum of instability, ranging from isolated nondisplaced occipital condyle fractures treated nonoperatively to highly unstable injuries with severely distracted craniocervical dissociation. Despite the evolution of understanding and improvement in the management of cases regarding catastrophic failure to diagnose, subsequent neurologic deterioration still occurs even in experienced trauma centers. The purpose of this article is to review the injuries that occur at the CCJ with the accompanying anatomy, presentation, imaging, classification, management, and outcomes.
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Affiliation(s)
- Catherine Olinger
- Harborview Medical Center, University of Washington Department of Orthopaedics and Sports Medicine, 908 Jefferson Street, Fifth Floor, Seattle, WA, USA.
| | - Richard Bransford
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA; Department of Neurological Surgery, University of Washington, Seattle, WA, USA; Spine Fellowship Program, University of Washington Department of Orthopaedics and Sports Medicine, 908 Jefferson Street, Fifth Floor, Seattle, WA, USA
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Tu Q, Chen H, Li Z, Chen Y, Xu A, Zhu C, Huang X, Ma X, Wang J, Zhang K, Yin Q, Xu J, Xia H. Anterior reduction and C1-ring osteosynthesis with Jefferson-fracture reduction plate (JeRP) via transoral approach for unstable atlas fractures. BMC Musculoskelet Disord 2021; 22:745. [PMID: 34461878 PMCID: PMC8406960 DOI: 10.1186/s12891-021-04628-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 08/18/2021] [Indexed: 11/14/2022] Open
Abstract
Background To introduce a novel transoral instrumentation in the treatment of unstable fractures of the atlas. Methods From January 2008 to May 2018, 22 patients with unstable C1 fractures who received Jefferson-fracture reduction plate (JeRP) via transoral approach were retrospectively analyzed. The case history and the radiographs before and after surgery were noted. The type of fracture, the reduction of the fracture, and position of the internal fixation were assessed through preoperative and postoperative CT scans. Results All 22 patients successfully underwent anterior C1-ring osteosynthesis using the JeRP system, with a follow-up of 26.84 ± 9.23 months. Among them, 9 patients had transverse atlantal ligament (TAL) injury, including 3 in Dickman type I and 6 in type II. The preoperative lateral mass displacement (LMD) decreased from 7.13 ± 1.46 mm to 1.02 ± 0.65 mm after the operation. Bone union was achieved in all patients without implant failure or loss of reduction. There were no surgery-related complications, such as wound infection, neurological deficit, or vertebral artery injury. However, atlantoaxial dislocation occurred in 3 patients with Dickman type I TAL injury 3 months postoperatively without any neurological symptoms or neck pain. Conclusions Transoral C1-ring osteosynthesis with JeRP is an effective surgical strategy to treat unstable atlas fractures with a safe, direct, and satisfactory reduction. The primary indication for the JeRP system is an unstable fracture (Gehweiler type I/III) or/ and TAL injury (Dickman type II). Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04628-4.
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Affiliation(s)
- Qiang Tu
- Department of Orthopaedics, PLA General Hospital of Southern Theatre Command: People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, 510010, Guangdong, China.,Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510010, Guangdong, China
| | - Hu Chen
- Department of Orthopaedics, PLA General Hospital of Southern Theatre Command: People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, 510010, Guangdong, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510010, Guangdong, China
| | - Zhan Li
- Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, China
| | - Yuyue Chen
- Department of Orthopaedics, PLA General Hospital of Southern Theatre Command: People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, 510010, Guangdong, China
| | - Aihong Xu
- Department of Orthopaedics, PLA General Hospital of Southern Theatre Command: People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, 510010, Guangdong, China
| | - Changrong Zhu
- Department of Orthopaedics, PLA General Hospital of Southern Theatre Command: People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, 510010, Guangdong, China
| | - Xianhua Huang
- Department of Orthopaedics, PLA General Hospital of Southern Theatre Command: People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, 510010, Guangdong, China
| | - Xiangyang Ma
- Department of Orthopaedics, PLA General Hospital of Southern Theatre Command: People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, 510010, Guangdong, China
| | - Jianhua Wang
- Department of Orthopaedics, PLA General Hospital of Southern Theatre Command: People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, 510010, Guangdong, China
| | - Kai Zhang
- Department of Orthopaedics, PLA General Hospital of Southern Theatre Command: People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, 510010, Guangdong, China
| | - Qingshui Yin
- Department of Orthopaedics, PLA General Hospital of Southern Theatre Command: People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, 510010, Guangdong, China
| | - Jianzhong Xu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Hong Xia
- Department of Orthopaedics, PLA General Hospital of Southern Theatre Command: People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, 510010, Guangdong, China. .,The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510010, Guangdong, China.
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