Traumatic Atlantoaxial and Fracture-Related Dislocation

Abstract

Traumatic atlantoaxial dislocation due to ligamentous and combined osseous injuries rarely occurs in adults. There are only few cases published in the literature. In this level 4 study, a cohort of nine consecutive patients suffering from traumatic atlantoaxial dislocation has been analyzed regarding morphology of injury, trauma mechanism, and outcome since 2007. Three types of those injuries have been found regarding direction of dislocation indicating the underlying ligamentous injuries as well as the accompanying grade of instability. Firstly, there was rotatory dislocation, if the alar ligaments were injured. Secondly, there occurred horizontal dislocation, when transverse atlantal ligament was damaged additionally. Thirdly, excessive ligamentous injury led to distraction of the atlantoaxial complex resulting in dissociation of the atlas against the axis. Additionally fractures of the atlas as well as of the odontoid process (type II or III according to Anderson/D'Alonzo) were diagnosed frequently. Atlantoaxial dislocation injuries, especially distraction injuries, offer a high risk for accompanied neurovascular disorders deserving reduction followed by surgical fixation. Only rotatory injuries leading to ligamentous damage solitarily can safely be successfully treated conservatively. Understanding of the injuries' morphology is essential, in order to set the correct diagnosis and to implicate the most advantageous treatment regime.