Traumatic Atlantoaxial and Fracture-Related Dislocation

Area of Science:

• Orthopedics
• Neurosurgery
• Traumatology

Background:

• Traumatic atlantoaxial dislocation is a rare injury in adults, often resulting from combined ligamentous and osseous trauma.
• Published literature on this condition is limited, necessitating further investigation into its characteristics and management.

Purpose of the Study:

• To analyze the morphology, trauma mechanisms, and outcomes of traumatic atlantoaxial dislocation in a cohort of adult patients.
• To classify injury types based on dislocation direction and associated ligamentous damage to guide treatment strategies.

Main Methods:

• A retrospective analysis of nine consecutive adult patients with traumatic atlantoaxial dislocation treated since 2007.
• Classification of injuries based on the direction of dislocation and identification of involved ligaments and associated fractures.

Main Results:

• Three distinct injury types were identified: rotatory (alar ligament injury), horizontal (transverse atlantal ligament involvement), and distraction (atlantoaxial complex dissociation).
• Associated fractures of the atlas and odontoid process (Anderson/D'Alonzo type II or III) were frequently observed.
• Distraction injuries presented a high risk of neurovascular complications, mandating prompt reduction and surgical fixation.

Conclusions:

• Understanding the specific morphology of traumatic atlantoaxial dislocation is essential for accurate diagnosis and optimal treatment selection.
• Rotatory dislocations involving only ligamentous damage may be managed conservatively, while other types, particularly distraction injuries, require surgical intervention.