[Atypical dislocated dens fracture type II with rotational atlantoaxial luxation after a riding accident].
Abstract: We present a rare case of a combined dislocated odontoid dens fracture type II (Anderson/D'Alonzo) and rotational atlantoaxial luxation in a 15-year-old girl who was involved in a riding accident.She fell off her horse after it had stopped suddenly, losing consciousness for a few minutes. At presentation in the hospital, she had no complaints other than limited, painful neck movement. Radiologically, a posterior dislocation of an odontoid type II fracture (Anderson/D'Alonzo) was found. Computed tomography reconstruction demonstrated a rotational, hooklike fixed luxation of the left atlantoaxial facet joint. Manual repositioning after application of a cervical collar failed. Therefore, operative treatment was indicated for this highly unstable fracture. Posterior transarticular atlantoaxial screw fixation according to Magerl was performed; an iliac corticocancellous bone graft was harvested and shaped to conform to the posterior processes of C1 and C2. Additionally a hook-claw atlas fixation of C1 was done.To our knowledge, this is the first case of adolescent atlantoaxial cervical spine trauma in combination with an odontoid fracture and fixed rotational luxation reported in literature.
Publication Date: 2009-05-01 PubMed ID: 19404596DOI: 10.1007/s00113-008-1542-5Google Scholar: Lookup
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Summary
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The research article discusses a unique case of a 15-year-old girl who suffered from a combined dislocated odontoid dens fracture type II and rotational atlantoaxial luxation due to a horse riding accident, and the subsequent surgical treatment implemented.
Background
- This case deals with a rare type of injury resulting from a horse riding accident. The 15-year-old girl fell from her horse and briefly lost her consciousness. This accident resulted in a combination of a dislocated odontoid dens fracture type II (or Anderson/D’Alonzo) and rotational atlantoaxial luxation. The atlantoaxial complex comprises the first two spinal vertebrae that allow the head to move side to side.
Initial Diagnosis
- Upon arriving at the hospital, the girl had no complaints other than limited, painful neck movement. Therefore, preliminary diagnosis involved radiological examinations that found a posterior dislocation of an odontoid fracture.
- Computer tomography reconstructions highlighted a rotational, hooklike fixed luxation of the left atlantoaxial facet joint. This luxation is a type of dislocation where the facets of spinal vertebrae are abnormally aligned.
Treatment and Surgery
- The conventional manual re-positioning of the fracture using a cervical collar was attempted but failed. As a result, surgical intervention was deemed necessary due to the highly unstable nature of the fracture.
- The performed surgery was a posterior transarticular atlantoaxial screw fixation according to the Magerl technique. This technique, named after its developer, is a well-known method for treating injuries involving the atlantoaxial complex.
- In addition to the Magerl technique, an iliac corticocancellous bone graft was harvested from the patient. This graft was shaped to match the posterior processes of the first and second cervical vertebrae (C1 and C2).
- Additionally, a hook-claw atlas fixation of the first cervical vertebra (C1) was performed to provide additional stability to the affected area.
Conclusion
- The researchers concluded that this case is unique as it represented a first of its kind combination of adolescent atlantoaxial cervical spine trauma with an odontoid fracture and fixed rotational luxation. With this reported case, new ground has been broken in identifying and managing similar future cases.
Cite This Article
APA
Hopf S, Buchalla R, Elhöft H, Rubarth O, Börm W.
(2009).
[Atypical dislocated dens fracture type II with rotational atlantoaxial luxation after a riding accident].
Unfallchirurg, 112(5), 517-520.
https://doi.org/10.1007/s00113-008-1542-5 Publication
Researcher Affiliations
- Neurochirurgische Klinik, Diakonissenkrankenhaus Flensburg, Flensburg, Germany. silke.hopf@freenet.de
MeSH Terms
- Accidental Falls
- Adolescent
- Animals
- Atlanto-Axial Joint / injuries
- Atlanto-Axial Joint / surgery
- Female
- Horses
- Humans
- Joint Dislocations / surgery
- Multiple Trauma / surgery
- Odontoid Process / injuries
- Odontoid Process / surgery
- Spinal Fractures / surgery
- Treatment Outcome
References
This article includes 13 references
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Citations
This article has been cited 8 times.- Zitouna K, Riahi H, Lassoued NB, Selmene MA, Barsaoui M, Drissi G. Traumatic Atlantoaxial Dislocation with an Odontoid Fracture: A Rare and Potentially Fatal Injury.. Asian J Neurosurg 2019 Oct-Dec;14(4):1249-1252.
- Ghailane S, Alsofyani MA, Pointillart V, Bouloussa H, Gille O. Traumatic posterior Atlanto-axial dislocation: case report of an atypical C1-C2 dislocation with an anterior arch fracture of C1.. BMC Musculoskelet Disord 2019 Dec 20;20(1):612.
- Musa A, Farhan SA, Lee YP, Uribe B, Kiester PD. Traumatic Atlantoaxial Lateral Subluxation With Chronic Type II Odontoid Fracture: A Case Report.. Int J Spine Surg 2019 Jan;13(1):79-83.
- Schröter C, Schulte-Sutum A, Busch M, Winkelmann M, Macke C, Zeckey C, Krettek C, Mommsen P. [Cervical spine injury in equestrian sports].. Unfallchirurg 2017 Jun;120(6):494-500.
- Petridis AK, Kinzel A, Blaeser K, Thissen J, Maslehaty H, Scholz M. Can Break-Dance Break Your Neck? C1/C2 Luxation with a Combined Dens Fracture Without Neurological Deficits in an 11-Year Old Boy After a Break-Dance Performance.. Clin Pract 2015 Sep 28;5(3):781.
- Nagoshi N, Suda K, Morita T, Matsumoto S, Iimoto S, Yasui K, Komatsu M, Kobayashi Y, Minami A, Toyama Y, Matsumoto M, Nakamura M. C1 posterior arch screw as an auxiliary anchor in posterior reconstruction for atlantoaxial dislocation associated with type II odontoid fracture: a case report and review of the literature.. Springerplus 2014;3:672.
- Meng H, Gao Y, Li M, Luo Z, Du J. Posterior atlantoaxial dislocation complicating odontoid fracture without neurologic deficit: a case report and review of the literature.. Skeletal Radiol 2014 Jul;43(7):1001-6.
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