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C1-C2 fractures

Definition
C1-C2 fractures are acute cervical spine injuries of the atlas and axis associated with a high rate of other spinal injuries, neurological morbidity, and biomechanical instability.
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Pathophysiology
The most common causes of C1-C2 fractures are mechanical falls and motor vehicle accidents.
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Disease course
Forced hyperextension, forced flexion, and compression to the upper cervical spine due to trauma can result in C1-C2 fractures, which causes complete or partial loss of all movements and/or sensations due to cervical spinal cord injury, neurologic deficit, respiratory failure, and death.
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Prognosis and risk of recurrence
30-day mortality associated with spinal cord injury is 20.2% in C1-C2 fracture.
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Key sources
The following summarized guidelines for the evaluation and management of C1-C2 fractures are prepared by our editorial team based on guidelines from the American Association of Neurological Surgeons (AANS/CNS 2013).
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Guidelines

1.Diagnostic investigations

Evaluation for vertebral artery injury: obtain imaging to assess for vertebral artery injury in patients with comminuted fractures of the axis body.
B
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2.Therapeutic procedures

Cervical immobilization, C1 fractures
Manage isolated fractures of C1 (fractures of the atlas) based on the specific fracture type and the integrity of the transverse atlantal ligament.
B
Perform external cervical immobilization alone for isolated fractures of C1 with an intact transverse atlantal ligament.
B

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  • Cervical immobilization (C2 fractures)

3.Surgical interventions

Surgical stabilization, C1 fractures: perform either external cervical immobilization alone or surgical fixation and fusion in patients with isolated fractures of C1 with disruption of the transverse atlantal ligament.
B

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  • Surgical stabilization, C2 fractures (odontoid fractures)

  • Surgical stabilization, C2 fractures (Hangman's fractures)

  • Surgical stabilization, C2 fractures (body fracture)