Treatment of Axis Ring Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU)

Overview

Journal Global Spine J

Publisher Sage Publications

Date 2018 Sep 14

PMID 30210957

Citations 7

Authors

Matti Scholz

Frank Kandziora

Philipp Kobbe

S Matschke

Philipp Schleicher

Christoph Josten

Affiliations

Soon will be listed here.

Abstract

Study Design: Narrative literature review and expert recommendation.

Objective: To establish treatment recommendations for axis ring fractures based on the knowledge of the experts of the Spine Section of the German Society for Orthopaedics and Trauma.

Methods: This recommendation summarizes the knowledge of the experts of the Spine Section of the German Society for Orthopaedics and Trauma with regard to the treatment of axis ring fractures based on a narrative literature review.

Results: Typical "hangman's fractures" with bilateral separation of the neural arch from C2 and atypical "hangman's fractures" with irregular fracture morphology are described. Computed tomography is the "gold" standard used to detect and analyse these fractures adequately. Furthermore, the detection of vertebral artery integrity is necessary. To classify axis ring fractures, the Levine-Edwards or Josten classification is recommended. In particular, the integrity of the C2/3 disc and the integrity of the anterior longitudinal ligament are used to determine the treatment strategy. While Levine-Edwards type I and type IIA (Josten type 1 and 2) fractures should be treated conservatively, Levine type II and type III (Josten type 3 and 4) fractures should be treated operatively. Levine-Edwards type II fractures will be predominately treated by anterior C2/3 fusion. Levine-Edwards type III fractures have to be primary reduced, if an anterior fusion is planned (anterior cervical discectomy and fusion [ACDF] C2/3). If a closed reduction of a type III fracture is impossible, an open reduction and posterior fixation/fusion is the treatment of choice.

Conclusion: Conservative treatment is predominantly reserved for Levine-Edwards I and IIA fractures. Operative treatment should be performed in case of Levine-Edwards II and III fractures.

Citing Articles

Analysis of the clinical characteristics of adult patients with hangman's fractures: A retrospective study based on multicenter clinical data.

Li G, Wang Q Front Surg. 2023; 10:949987.

PMID: 37082367 PMC: 10110880. DOI: 10.3389/fsurg.2023.949987.

Analysis of the clinical characteristics and predisposing factors for neurological deficit with Hangman fractures.

Li G, Wang Q J Orthop Surg Res. 2023; 18(1):179.

PMID: 36890563 PMC: 9996926. DOI: 10.1186/s13018-023-03650-7.

Detailed observation of anatomical location and pattern in Hangman's fracture based on computed tomography three-dimensional reconstruction.

Li G, Wang Q J Orthop Surg Res. 2023; 18(1):136.

PMID: 36823607 PMC: 9948456. DOI: 10.1186/s13018-023-03622-x.

Is it feasible to treat unstable traumatic spondylolisthesis of the axis via posterior fixation without fusion?.

Zhang J, Li G, Wang Q BMC Musculoskelet Disord. 2023; 24(1):122.

PMID: 36782156 PMC: 9923926. DOI: 10.1186/s12891-023-06233-z.

Saradhi's single stage, anterior sequential reduction utilizing C3 for type III hangman's fracture: A novel technique.

Mudumba V, Pavan S, Alugolu R J Craniovertebr Junction Spine. 2022; 13(1):80-84.

PMID: 35386244 PMC: 8978851. DOI: 10.4103/jcvjs.jcvjs_83_21.

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