Direct Internal Fixation for Unstable Atlas Fractures

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Radiology

Background:

• Unstable atlas fractures pose significant management challenges.
• Traditional fixation methods may compromise craniocervical and atlantoaxial motion.

Purpose of the Study:

• To evaluate the radiologic and clinical outcomes of direct internal fixation for unstable atlas fractures.
• To assess the efficacy of C1 lateral mass screws, rods, and transverse connector constructs.

Main Methods:

• Retrospective analysis of 12 patients with unstable atlas fractures.
• Surgical treatment using C1 lateral mass screws, rods, and transverse connectors.
• Radiographic assessment of anterior atlantodental interval (AADI) and CT for bony healing; clinical assessment of pain (VAS) and function (NDI).

Main Results:

• Successful bony healing in 11 of 12 patients by 1 year post-surgery.
• Mean postoperative AADI improved and remained stable at 6 months and 1 year.
• Significant reduction in neck pain (mean VAS 0.92) and disability (mean NDI 8.08).

Conclusions:

• Direct internal fixation is a viable motion-preserving technique for unstable atlas fractures.
• This method achieves good reduction, stabilization, and functional recovery.
• Preservation of craniocervical and atlantoaxial motion is a key benefit.