====== Axis fracture management ======

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Suppose an [[axis fracture]] involves the adjacent segment instability and even dislocation. In that case, it can easily lead to high cervical spinal cord injury and vertebro-basilar artery insufficiency, thus resulting in quadriplegia and even a life-threatening condition. The principle for the surgery is that the axis fracture type should be considered, and the adjacent unstable segments should be fixed to restore the stability between C1/2/3. A personalized surgical method should be selected for each patient, thus achieving an effective fixation and preserving the movement phase of the spine as much as possible
((Tan MS, Zhang GB. Thoughts on therapies and surgical indications for atlantoaxial instability. Chinese Journal of Spine and Spinal Cord. 2006;16:330–331.))

Management of axis fractures in the elderly remains controversial.

===== Umbrella reviews =====

Joaquim et al. performed an [[umbrella review]] of [[systematic review]]s evaluating studies about the [[axis fracture management]] that identify potential modifiers in the [[axis fracture treatment]]. These [[modifier]]s were grouped according to the new AO UCIC.
Eight systematic reviews were included. 

They were divided into three groups: (1) [[Axis body fracture]]s - one study, (2) [[Hangman´s fracture]]s - one study, and (3) [[Odontoid fracture]]s, six studies. For axis body fractures, most injuries were treated non-operatively, except some [[Benzel type 3 fracture]]s ([[AO Spine Upper Cervical Injury Classification System type A]]) with displacement or severe comminution (M1). [[Hangman´s fracture]]s classified as [[Levine and Effendi classification]] I and [[Levine and Edwards classification]] I and II were successfully treated non-operatively, with no modifiers identified for non-union or instability. For Levine-Edwards type IIA and III, surgery was generally recommended, but these should be classified as [[AO Spine Upper Cervical Injury Classification System type B]] and [[AO Spine Upper Cervical Injury Classification System type C]], respectively, without a need for modifiers. For [[odontoid fracture]]s, fractures in the dens base, with [[displacement]], or in elderly patients were associated with non-union (M1), and patients' specific factors (surgical condition) seem to affect the decision of treatment (M3) for considering surgery. They identified from the literature some [[axis fracture]] characteristics that seem to affect the [[treatment decision]] in historical series. Knowledge of these modifiers may further enhance the system's clinical utility
((Joaquim AF, Bigdon SF, Camino-Willhuber G, Öner CF, Schnake KJ, Bransford R, Chhabra HS, El-Skarkawi M, Vaccaro AR, Schroeder GD; AO Spine Knowledge Forum Trauma & Infection. The [[AO Spine Upper Cervical Injury Classification System]] (AO UCIC) - An [[Umbrella Review]] of Traumatic Axis Injuries Factors that May Affect Treatment Decision. Global Spine J. 2025 Mar 29:21925682251333300. doi: 10.1177/21925682251333300. Epub ahead of print. PMID: 40156313.)).