Unilateral C1-C2 vertical distraction injuries: Can we treat conservatively?

Area of Science:

• Orthopedic Surgery
• Radiology
• Trauma Care

Background:

• Traumatic atlantoaxial joint (AAJ) vertical distraction injuries are part of a spectrum of craniocervical junction trauma.
• Previous research focused on bilateral AAJ injuries, leaving a gap in understanding unilateral or incomplete injuries.
• Clinical management of partial AAJ injuries is uncertain due to potential delayed instability.

Purpose of the Study:

• To characterize injury patterns of incomplete or unilateral AAJ vertical distraction.
• To evaluate the clinical courses and outcomes of patients with these specific injuries.

Main Methods:

• Retrospective review of MRI and CT scans from a Level I Trauma Center (2006-2021).
• Inclusion criteria: age >18, recent trauma, unilateral AAJ distraction (LMI >2.6 mm).
• Classification of soft-tissue injury via MRI; data collected via chart review.

Main Results:

• Five patients (3 male, 2 female, average age 51) with unilateral AAJ distraction (average LMI 4.2 mm).
• Injuries primarily from motor vehicle accidents; three patients had concomitant extremity fractures.
• No complete ligamentous tears; all patients treated conservatively with cervical collars, showing no late instability.

Conclusions:

• Unilateral or incomplete AAJ vertical distraction injuries require careful evaluation, including MRI for ligamentous assessment.
• In the absence of unstable ligamentous injury, conservative management is safe and effective.
• This study highlights successful nonoperative treatment for unilateral AAJ distraction injuries without instability.