Four-Point C2 Fixation for Unstable Atlas Fractures: Technical Note

Traumatic burst fractures of the atlas occur with axial loading of the cervical spine. Many of these injuries can be treated by nonsurgical management with external orthosis; however, cases with transverse ligament disruption or significant C1 lateral mass displacement require internal reduction and fixation. In patients with poor bone quality in the setting of osteoporosis or chronic illness, atlanto-axial fixation and reduction of the fracture can be a challenge, necessitating extension of fusion to the occiput, which significantly limits the range of motion. A 63-year-old man with a history of HIV, Parkinson's disease, and osteoporosis presented with neck pain after a fall from sitting height. Imaging studies revealed an unstable C1 burst fracture with displacement of the C1 lateral masses. A novel four-point C2 fixation technique was used to reduce the fracture and provide stability to the construct in the setting of poor bone quality. To our knowledge, this is the first manuscript to describe the technique of four-point axis fixation for surgical reduction and fixation of an unstable atlas fracture.