Axis fracture management

• Surgical Management of Unstable Atlas Fractures: A Single Institutional Retrospective Review with Comparison of Occipitocervical and Atlantoaxial Fusion Outcomes
• Distal ulnar neck fracture displacement with forearm rotation: A biomechanical cadaveric study
• Clinical Outcomes and Risk Factors Associated with Spinal Kyphotic Deformity Following Osteoporotic Vertebral Fracture
• Changes in sagittal spinopelvic alignment are associated with increased pain and impaired function in multiple myeloma patients
• Qi-Gu capsule alleviates osteoporosis by inhibiting mesenchymal stem cell senescence via the HIF-1alpha/AMPK axis
• X-Linked Hypophosphatemia Management in Adults: An International Working Group Clinical Practice Guideline
• The AO Spine Upper Cervical Injury Classification System (AO UCIC) - An Umbrella Review of Traumatic Axis Injuries Factors that May Affect Treatment Decision
• Three-Dimensional Mapping of Distal Clavicle Fractures: Displacement Patterns and Clinical Implications for Surgical Management

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 ¹⁾

Management of axis fractures in the elderly remains controversial.

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

They were divided into three groups: (1) Axis body fractures - one study, (2) Hangman´s fractures - one study, and (3) Odontoid fractures, six studies. For axis body fractures, most injuries were treated non-operatively, except some Benzel type 3 fractures (AO Spine Upper Cervical Injury Classification System type A) with displacement or severe comminution (M1). Hangman´s fractures 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 fractures, 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 ²⁾.