Abstract
A retrospective analysis of 165 patients admitted to Hermann Hospital with acute injuries of the axis vertebra revealed 68 (41%) dens fractures, 62 (38%) cases of traumatic spondylolisthesis (“hangman's” fracture), 21 (13%) extension teardrop fractures, 10 (6%) hyperextension dislocations, and 2 (1.0%) fractures each of the laminae and spinous processes. Of the 68 dens fractures, none (0%) were of the Anderson and D'Alonzo Type I; 21 (31%) were Type II (“high”); and 47 (69%) were Type III (“low”). The 62 traumatic spondylolistheses included 13 (21%) Effendi type I, 35 (56%) type II and 3 (5%) type III. This review disclosed an additional 11 (18%) patients with an atypical variety of traumatic spondylolisthesis, not previously reported, in which one or both fractures involved the posterior cortex of the axis body. Of the axis injuries 31 (18%) were limited to the axis body alone. Of these, 21 (61%) were hyperextension teardrop fractures and 10 (32%) were hyperextension dislocations. Axis injuries were associated with acute injuries of other cervical vertebrae in 14 (8%) of the patients.
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Alexander E Jr, Forsyth HF, Davis CH, Nashold BS Jr (1958) Dislocation of the atlas on the axis. The value of early fusion of C1, C2 and C3. J Neurosurg 15:353
Amyes EW, Anderson FM (1956) Fracture of the odontoid process. Arch Surg 72:377
Anderson LD, D'Alonzo RT (1974) Fractures of the odontoid process of the axis. J Bone Joint Surg [Am] 56:1663
Apuzzo MLJ, Heiden JS, Weiss MH, Ackerson TT, Harvey JP, Kurze T (1978) Acute fractures of the odontoid process. J Neurosurg 48:85
Banna M, (1985) Clinical radiology of the spine and the spinal cord. Aspen System Corp, Rockville
Bohler J (1982) Anterior stabilization for acute fractures and non-unions of the dens. J Bone Joint Surg [Am] 64:18
Bohlman HH (1979) Acute fractures and dislocations of the cervical spine. J Bone Joint Surg [Am] 61:1119
Borne GM, Bedou GL, Pinaudeau M (1984) Treatment of pedicular fractures: A clinical study and screw fixation technique. J Neurosurg 60:88
Brashear HR Jr, Venters GC, Preston ET (1975) Fractures of the neural arch of the axis. J Bone Joint Surg [Am] 57:879
Bucholz RW (1981) Unstable hangman's fractures. Clin Orthop 154:119
Cornish BL (1968) Traumatic spondylolisthesis of the axis. J Bone Joint Surg [Br] 50:31
Dalinka MK, Kessler H, Weiss M (1985) The radiologic evaluation of spinal trauma. Em Med Cl N A 3:475
Davis D, Bohlman H, Walker AE, Fisher R, Robinson R (1971) The pathological findings in fatal craniospinal injuries. J Neurosurg 34:603
Dickson H, Engel S, Blum P, Jones RF (1984) Odontoid fractures, systemic disease and conservative care. Aust NZ J Surg 54:243
Reference deleted
Dunn ME, Seljeskog EL (1986) Experience in the management of odontoid process injuries: An analysis of 128 cases. Neurosurgery 18:306
Edeiken-Monroe BE, Wagner LK, Harris JH Jr (1986) Hyperextension dislocation of the cervical spine. AJNR 7:135
Effendi B, Roy D, Cornish B, Dussault RG, Laurin CA (1981) Fractures of the ring of the axis. A classification based on the analysis of 131 cases. J Bone Joint Surg [Br] 63:319
Elliott JM, Rogers LF, Wissinger JP, Lee JF (1972) The Hangman's fracture: Fractures of the neural arch of the axis. Radiology 104:303
Federle M, Brandt-Zawadski M (eds) (1982) Computed tomography in the evaluation of trauma. Williams and Wilkins. Baltimore
Francis WR, Fielding JW (1978) Traumatic spondylolisthesis of the axis. Orthop Clin North Am 9:1011
Francis WR, Fielding JW, Hawkins RJ, Pepin J, Hensinger R (1981) Traumatic spondylolisthesis of the axis. J Bone Joint Surg [Br] 63:313
Garber JN (1964) Abnormalities of the atlas and the axis vertebrae. J Bone Joint Surg [Am] 46:1782
Gehweiler JA Jr, Clark WM, Schaaf RE, Powers B, Miller MD (1979) Cervical spine trauma: The common combined conditions. Radiology 130:77
Gehweiler JA, Duff DE, Martinez S, Miller MD, Clark WM (1976) Fractures of the atlas vertebra. Skeletal Radiol 1:97
Gehweiler JA Jr, Martinez S, Clark WM, Miller MD, Stewart GC Jr (1977) Spondylolisthesis of the axis vertebra. AJR 128:682
Gehweiler JA Jr, Osborne RI Jr, Becker RF (1980) The radiology of vertebral trauma. WB Saunders. Philadelphia
Gerlock AJ Jr, Mirfakhraee M (1983) Computed tomography and Hangman's fractures. South Med J 76:727
Gray's Anatomy (1973) 29th Edition. Lea and Febiger, Philadelphia
Hadley MN, Browner CM, Liu SS, Sonntag VK (1988) New subtype of acute odontoid fractures (Type IIa). Neurosurgery 22:67
Hanssen AD, Cabanela ME, Cass JR (1987) Fractures of the dens (odontoid process). In: Advances in orthopaedic surgery. Williams and Wilkins, Baltimore
Harris JH Jr, Edeiken-Monroe BE (1987) Radiology of acute cervical spine trauma (2nd edn). Williams and Wilkins, Baltimore
Harris JH Jr, Burke JT, Ray RD, Nichols-Hostetter S, Lester RG (1984) Low (type III) odontoid fracture: A new radiographic sign. Radiology 153:353
Holdsworth FW, (1963) Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg [Br] 45:6
Holdsworth FW (1970) Fractures, dislocations and fracture-dislocations of the cervical spine. J Bone Joint Surg [Am] 52:1534
Kazarian L (1981) Injuries to the human spinal column. Exerc Sport Sci Rev 9:297
Lee C, Kim KS, Rogers LF (1982) Triangular cervical vertebral body fractures. AJR 138:1123
Levine AM, Edwards CC (1985) The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg [Am] 67:217
Lind B, Nordwall A, Sihlbom H (1987) Odontoid fractures treated with halo-vest. Spine 12:173
Maiman DJ, Larson SJ (1982) Management of odontoid fractures. Neurosurgery 11:471
Miller MD, Gehweiler JA, Martinez S, Charlton OP, Daffner RH (1978) Significant new observations on cervical spine trauma. AJR 130:659
Mirvis SE, Young JWR, Lim C, Greenberg J (1987) Hangman's fracture: Radiologic assessment in 27 cases. Radiology 163:713
Mouradian WH, Fietti VG, Cochran GVB, Fielding JW, Young J (1978) Fractures of the odontoid: A laboratory and clinical study of the mechanisms. Orthop Clin North Am 9:985
Paradis GR, Janes JM (1973) Posttraumatic atlantoaxial instability: The fate of the odontoid process fracture in 46 cases. J Trauma 13:359
Pepin JW, Bourne RB, Hawkins RJ (1985) Odontoid fractures, with special reference to the elderly patient. Clin Orthop 193:178
Rogers LF (1982) The radiology of skeletal trauma. Churchill Livingston, New York
Rothman RR, Simeone FA (1975) The spine. W.B. Saunders, Philadelphia
Ryan MD, Taylor TKK (1982) Odontoid fractures: A rational approach to treatment. J Bone Joint Surg [Br] 64:416
Schatzer J, Rorabeck CH, Waddell JP (1971) Fractures of the dens (odontoid process). J Bone Joint Surg [Br] 53: 392
Scher AT (1980) Diversity of radiological features in hyperextension injury of the cervical spine. S Afr Med J 58:27
Schneider RC, Livingston KE, Cave AJE, Hamilton G (1965) “Hangman's fracture” of the cervical spine. J Neurosurg 22:141
Selecki BR, Williams HBL (1970) Injuries to the cervical spine and cord in man. Australian Medical Association. Mervyn Archdall Medical Monograph Number 7, Australasian Medical Publishing Co., New South Wales
Shapiro R, Youngberg AS, Rothman SL (1973) The differential diagnosis of traumatic lesions of the occipito-atlantoaxial segment. Radiol Clin North Am 11:505
Sherk HH, Howard T (1983) Clinical and pathologic correlations in traumatic spondylolisthesis of the axis. Clin Orthop 174:122
Sherk HH, Nicholson JT, Chung SMK (1978) Fractures of the odontoid process in young children. J Bone Joint Surg [Am] 60:921
Southwick WO (1980) Management of fractures of the dens (odontoid process). J Bone Joint Surg [Am] 62:482
Wackenheim A (1974) Roentgen diagnosis of the craniovertebral region. Springer, Berlin Heidelberg New York
Waddell JP, Reardon GP, (1983) Atlantoaxial arthrodesis to treat odontoid fractures. Can J Surg 26:255
Wang GJ, Mabie KN, Whitehill R, Stamp WG (1984) The nonsurgical management of odontoid fractures in adults. Spine 9:229
Weir DC (1975) Roentgenographic signs of cervical injury. Clin Orthop 109:9
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This work was supported, in part, by a grant from the John S. Dunn Foundation
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Burke, J.T., Harris, J.H. Acute injuries of the axis vertebra. Skeletal Radiol 18, 335–346 (1989). https://doi.org/10.1007/BF00361422
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DOI: https://doi.org/10.1007/BF00361422